Provider Demographics
NPI:1306554761
Name:AWUNGAFAC, BERTRAND
Entity type:Individual
Prefix:
First Name:BERTRAND
Middle Name:
Last Name:AWUNGAFAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 HANOVER PKWY APT D1
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2041
Mailing Address - Country:US
Mailing Address - Phone:240-486-5242
Mailing Address - Fax:
Practice Address - Street 1:7006 HANOVER PKWY APT D1
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2041
Practice Address - Country:US
Practice Address - Phone:240-486-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician