Healthcare Provider Details

I. General information

NPI: 1699548545
Provider Name (Legal Business Name): CARA NICOLE BONELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/15/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 OLD ANNAPOLIS RD STE A
COLUMBIA MD
21045-1990
US

IV. Provider business mailing address

9030 COLUMBIA ROAD UNIT A
COLUMBIA MD
21044
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30625
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: