Provider Demographics
NPI:1962549543
Name:PRUM, BUNTHY (LCSW)
Entity type:Individual
Prefix:MISS
First Name:BUNTHY
Middle Name:
Last Name:PRUM
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 1:1023 MACARTHUR BLVD.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3965
Mailing Address - Country:US
Mailing Address - Phone:510-874-7152
Mailing Address - Fax:510-474-1473
Practice Address - Street 1:1023 MACARTHUR BLVD.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3965
Practice Address - Country:US
Practice Address - Phone:510-874-7152
Practice Address - Fax:510-474-1473
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical