Provider Demographics
NPI:1770881815
Name:BUNGU, NAZA (LPC, LADC)
Entity type:Individual
Prefix:
First Name:NAZA
Middle Name:
Last Name:BUNGU
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:203-848-9350
Mailing Address - Fax:
Practice Address - Street 1:840 BOSTON POST RD STE 5
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1848
Practice Address - Country:US
Practice Address - Phone:203-848-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-13
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1186101YA0400X
CT2029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008045424Medicaid