Provider Demographics
NPI:1669556528
Name:BUNCK, LINDA JOAN (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JOAN
Last Name:BUNCK
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 1:3927 SE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4830
Mailing Address - Country:US
Mailing Address - Phone:239-945-0378
Mailing Address - Fax:239-945-0378
Practice Address - Street 1:1342 COLONIAL BLVD
Practice Address - Street 2:SUITE K-119
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1013
Practice Address - Country:US
Practice Address - Phone:239-910-0955
Practice Address - Fax:239-945-0378
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0440YMedicare PIN