Healthcare Provider Details

I. General information

NPI: 1518190446
Provider Name (Legal Business Name): CLEONIA BONAPARTE TERRY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE SUITE 200
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

2041 MARTIN LUTHER KING JR SEAVE 303
WASHINGTON DC
20020-7036
US

V. Phone/Fax

Practice location:
  • Phone: 202-889-7900
  • Fax: 202-610-3095
Mailing address:
  • Phone: 202-889-7900
  • Fax: 202-610-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078592
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: