Healthcare Provider Details

I. General information

NPI: 1851450878
Provider Name (Legal Business Name): BONNIE JOYCE HALLISEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DORCHESTER AVE
DORCHESTER MA
02122-1327
US

IV. Provider business mailing address

1500 DORCHESTER AVE
DORCHESTER MA
02122-1327
US

V. Phone/Fax

Practice location:
  • Phone: 617-825-5000
  • Fax: 617-288-5991
Mailing address:
  • Phone: 617-825-5000
  • Fax: 617-288-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103203
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103203
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: