Provider Demographics
NPI:1063094779
Name:KUNST, MELENDA (SW21903)
Entity type:Individual
Prefix:
First Name:MELENDA
Middle Name:
Last Name:KUNST
Suffix:
Gender:F
Credentials:SW21903
Other - Prefix:
Other - First Name:MELENDA
Other - Middle Name:
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2566 SW ABATE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2558
Mailing Address - Country:US
Mailing Address - Phone:772-626-2941
Mailing Address - Fax:
Practice Address - Street 1:2566 SW ABATE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2558
Practice Address - Country:US
Practice Address - Phone:772-626-2941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW219031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical