Provider Demographics
NPI:1760930754
Name:DUNBAR, CARL I
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:DUNBAR
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 KNIGHTS RD
Mailing Address - Street 2:APT 7-18
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2853
Mailing Address - Country:US
Mailing Address - Phone:267-266-1712
Mailing Address - Fax:
Practice Address - Street 1:3131 KNIGHTS RD
Practice Address - Street 2:APT 7-18
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2853
Practice Address - Country:US
Practice Address - Phone:267-266-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3060Medicaid