Provider Demographics
NPI:1265594386
Name:LUNSFORD, MIDGE M (MSW)
Entity type:Individual
Prefix:MS
First Name:MIDGE
Middle Name:M
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 DE REIMER AVE
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1518
Mailing Address - Country:US
Mailing Address - Phone:718-320-9203
Mailing Address - Fax:718-320-9203
Practice Address - Street 1:3919 DYRE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2507
Practice Address - Country:US
Practice Address - Phone:718-974-6622
Practice Address - Fax:718-320-9203
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029548-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1056560OtherBEACON HEALTH STRATEGIES
NY163907OtherVALUEOPTIONS
NY7480145OtherGHI
NY1056560OtherBEACON HEALTH STRATEGIES