Provider Demographics
NPI:1720355696
Name:BUNIN, SUZANNE (SPECIALIST)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:BUNIN
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17200 E. TEN MILE RD.
Mailing Address - Street 2:SUITE 135
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021
Mailing Address - Country:US
Mailing Address - Phone:586-279-3250
Mailing Address - Fax:
Practice Address - Street 1:17200 E 10 MILE RD
Practice Address - Street 2:SUITE 135
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3355
Practice Address - Country:US
Practice Address - Phone:586-279-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156572103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool