Provider Demographics
NPI:1952618845
Name:BUNKER, LORENA SOTO (LMFT, MED)
Entity type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:SOTO
Last Name:BUNKER
Suffix:
Gender:F
Credentials:LMFT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2245
Mailing Address - Country:US
Mailing Address - Phone:860-985-5215
Mailing Address - Fax:860-725-2539
Practice Address - Street 1:674 PROSPECT AVE STE 102
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4288
Practice Address - Country:US
Practice Address - Phone:860-985-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008098282Medicaid