Provider Demographics
NPI:1780430942
Name:LUNDY, EILEEN MARIE
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:LUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 BIDWELL PKWY UNIT 204
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3026
Mailing Address - Country:US
Mailing Address - Phone:321-848-8420
Mailing Address - Fax:
Practice Address - Street 1:5641 BIDWELL PKWY UNIT 204
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3026
Practice Address - Country:US
Practice Address - Phone:321-848-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health