Provider Demographics
NPI:1629136536
Name:MUNN, EUNICE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:
Last Name:MUNN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-0063
Mailing Address - Country:US
Mailing Address - Phone:574-825-7662
Mailing Address - Fax:574-825-3254
Practice Address - Street 1:106 EAST BERRY STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540
Practice Address - Country:US
Practice Address - Phone:574-825-7662
Practice Address - Fax:574-825-3254
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003511A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical