Provider Demographics
NPI:1124169370
Name:BUNYAN, CATHERINE (LMSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BUNYAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1523
Mailing Address - Country:US
Mailing Address - Phone:845-548-5536
Mailing Address - Fax:
Practice Address - Street 1:50 SANITORIUM RD
Practice Address - Street 2:BLDG F
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3555
Practice Address - Country:US
Practice Address - Phone:845-364-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65786104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker