Healthcare Provider Details

I. General information

NPI: 1235095738
Provider Name (Legal Business Name): VANESSA JOY BONGIOVANNI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12006 WINTERCREST DR APT 136
LAKESIDE CA
92040-3756
US

IV. Provider business mailing address

10516 QUAIL CANYON RD
EL CAJON CA
92021-2241
US

V. Phone/Fax

Practice location:
  • Phone: 619-985-5076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number134512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: