Healthcare Provider Details

I. General information

NPI: 1699686006
Provider Name (Legal Business Name): GABRIELLE JOI BONNEAU LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 BERGENLINE AVE
UNION CITY NJ
07087-3582
US

IV. Provider business mailing address

407 HIGHLAND AVE # 309
ORANGE NJ
07050-2419
US

V. Phone/Fax

Practice location:
  • Phone: 201-259-8649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07514800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: