Provider Demographics
NPI:1063147221
Name:VAN DUNEM BARTOLOMEU DE FARIA, LUANA MARIA
Entity type:Individual
Prefix:
First Name:LUANA
Middle Name:MARIA
Last Name:VAN DUNEM BARTOLOMEU DE FARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 SUMMER CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7505
Mailing Address - Country:US
Mailing Address - Phone:786-523-1242
Mailing Address - Fax:
Practice Address - Street 1:2010 AL LIPSCOMB WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2773
Practice Address - Country:US
Practice Address - Phone:786-523-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical