MEDICARE: LAURA M LOSINGER-BONSERA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R-059832-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400001497	OTHER	NY	PTAN

General Provider Information

NPI Number	:	1699947952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M LOSINGER-BONSERA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 671
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-0671
Country	:	US
Telephone Number	:	631-334-8410
Fax Number	:

Provider Business Practice Location Address
First Line	:	368 VETERANS MEMORIAL HWY
Second Line	:	(SUITE 1)
City	:	COMMACK
State	:	NY
Zip	:	11725-4322
Country	:	US
Telephone Number	:	631-334-8410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/25/2009

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