Provider Demographics
NPI:1215927041
Name:BUNTON, MIRIAM ASMAR (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:ASMAR
Last Name:BUNTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12413 RUSTIC VIEW CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6287
Mailing Address - Country:US
Mailing Address - Phone:813-891-9619
Mailing Address - Fax:727-820-9707
Practice Address - Street 1:145 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3015
Practice Address - Country:US
Practice Address - Phone:727-744-4489
Practice Address - Fax:727-820-9707
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0004133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7600BMedicare ID - Type Unspecified