Provider Demographics
NPI:1669651030
Name:BULNES, ANA K (LICSW)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:K
Last Name:BULNES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16782 SW 88TH ST # 344
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5934
Mailing Address - Country:US
Mailing Address - Phone:802-557-1065
Mailing Address - Fax:
Practice Address - Street 1:16782 SW 88TH ST # 344
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5934
Practice Address - Country:US
Practice Address - Phone:802-557-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1241931041C0700X
TX1063111041C0700X
MELC215201041C0700X
VT08900011761041C0700X
FLSW181481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106311OtherTX STATE LCSW
VT0890001176OtherVERMONT STATE LICENSE
MA124193OtherMA STATE LICSW
FLSW18148OtherFL STATE LCSW
MELC21520OtherME STATE LCSW