Healthcare Provider Details

I. General information

NPI: 1396077202
Provider Name (Legal Business Name): ANNETTE BONET LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

234 E 149TH ST
BRONX NY
10451-5504
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-6001
  • Fax: 718-579-4860
Mailing address:
  • Phone: 718-579-6001
  • Fax: 718-579-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: