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NPI Code Detail

MEDICARE: LIANE E BONIFACIO LCSW

MEDICARE: LIANE E BONIFACIO 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
11041C0700XClinical Social Worker083154NY

General Provider Information

NPI Number : 1952618050
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIANE E BONIFACIO LCSW
Provider Business Mailing Address
First Line : 3601 JOHNSON AVE APT 4H
Second Line :
City : BRONX
State : NY
Zip : 10463-1636
Country : US
Telephone Number : 914-426-6999
Fax Number :
Provider Business Practice Location Address
First Line : 1311 MAMARONECK AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5221
Country : US
Telephone Number : 914-426-6999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2010
Last Update Date : 05/03/2024

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Directions to “ LIANE E BONIFACIO LCSW” Practice Location

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