Provider Demographics
NPI:1487990966
Name:BUNBURY, VERONICA (CASE MANAGEMENT)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BUNBURY
Suffix:
Gender:F
Credentials:CASE MANAGEMENT
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:BUNBURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FAMILY SERVICES COUN
Mailing Address - Street 1:750 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:SUITE 119
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3118
Mailing Address - Country:US
Mailing Address - Phone:407-558-5058
Mailing Address - Fax:844-246-6240
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 119
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3118
Practice Address - Country:US
Practice Address - Phone:407-558-5058
Practice Address - Fax:844-246-6240
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010444500Medicaid