Healthcare Provider Details

I. General information

NPI: 1003210303
Provider Name (Legal Business Name): BONNIE K. SCRANTON MSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WINTONBURY AVE SUITE 318
BLOOMFIELD CT
06002-2470
US

IV. Provider business mailing address

682 FERN ST
WEST HARTFORD CT
06107-1420
US

V. Phone/Fax

Practice location:
  • Phone: 860-878-8142
  • Fax: 860-242-1476
Mailing address:
  • Phone: 860-878-8142
  • Fax: 860-242-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007403
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. BONNIE SCRANTON
Title or Position: OWNER/PRESIDENT
Credential: LCSW
Phone: 860-878-8142