Provider Demographics
NPI:1780775361
Name:MACPHERSON, BAMBI LYNN (LCSW-C)
Entity type:Individual
Prefix:
First Name:BAMBI
Middle Name:LYNN
Last Name:MACPHERSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:BAMBI
Other - Middle Name:LYNN
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:2206 SE 27TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3328
Mailing Address - Country:US
Mailing Address - Phone:240-344-7383
Mailing Address - Fax:
Practice Address - Street 1:2206 SE 27TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-3328
Practice Address - Country:US
Practice Address - Phone:240-344-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10656101YM0800X
FLSW172891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE 102Medicare ID - Type Unspecified