1194015164 NPI number — MISS LYMA DUNBAR MSW, CISW5632

Table of content: MISS LYMA DUNBAR MSW, CISW5632 (NPI 1194015164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194015164 NPI number — MISS LYMA DUNBAR MSW, CISW5632

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNBAR
Provider First Name:
LYMA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW, CISW5632
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194015164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7842 TOLEDO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32822-8072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-263-9939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 S SWOOPE AVE
Provider Second Line Business Practice Location Address:
#211
Provider Business Practice Location Address City Name:
MAITLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32751-5704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-699-0444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ISW 5632 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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