Provider Demographics
NPI:1548504715
Name:ROSADO-BUNKLEY, DAISY (LCSW)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:ROSADO-BUNKLEY
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 1:975 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6759
Mailing Address - Country:US
Mailing Address - Phone:347-210-1473
Mailing Address - Fax:
Practice Address - Street 1:2412 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:855-681-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE061OtherAGENCY MEDICARE
00355940OtherAGENCY MEDICAID
NY1285628552OtherAGENCY NPI