Provider Demographics
NPI:1144266255
Name:BUNKER, DEBORAH (LICSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BUNKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LAKE AVE N
Mailing Address - Street 2:UMMMC, EMERGENCY MENTAL HEALTH SERVICE
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST STE 460
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1817
Practice Address - Country:US
Practice Address - Phone:508-796-1411
Practice Address - Fax:508-796-1455
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1056051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA105605OtherLICSW LICENSE FOR MA