Doctor Name: | MRS. DIANA LEE BUNDAY |
NPI Number: | 1629128392 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW-C |
License Number: | 03924 |
Business Practice Address: | 21221 Georgia Ave Brookeville, MD - 208331135 |
Business Phone Number: | 3015704168 |
Business Fax Number: | |
Mailing Address: | 21221 Georgia Ave, BROOKEVILLE |
State: | MD |
Postal Code: | 208331135 |
Phone Number: | 3015704168 |
Fax Number: | |
NPI Enumeration Date: | 01/12/2007 |
NPI Last Update Date: | 11/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 03924 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |