Provider Demographics
NPI:1205481991
Name:NAZA BUNGU LLC
Entity type:Organization
Organization Name:NAZA BUNGU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-848-9350
Mailing Address - Street 1:840 BOSTON POST RD STE 5
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1848
Mailing Address - Country:US
Mailing Address - Phone:203-445-6593
Mailing Address - Fax:
Practice Address - Street 1:840 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1847
Practice Address - Country:US
Practice Address - Phone:203-445-6593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAZA BUNGU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT8045424Medicaid