Provider Demographics
NPI:1679841696
Name:KUNKEL, PRISCILLA (LCSW)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 CHINOOK TRL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4080
Mailing Address - Country:US
Mailing Address - Phone:203-610-1585
Mailing Address - Fax:407-442-3710
Practice Address - Street 1:236 PASADENA PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3828
Practice Address - Country:US
Practice Address - Phone:321-594-8815
Practice Address - Fax:407-442-3710
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW105491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004577600Medicaid