Healthcare Provider Details

I. General information

NPI: 1699283531
Provider Name (Legal Business Name): RENEE JEANNE BONNEY L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FOREST AVE
BUFFALO NY
14213
US

IV. Provider business mailing address

400 FOREST AVE.
BUFFALO NY
14213-1298
US

V. Phone/Fax

Practice location:
  • Phone: 716-885-2261
  • Fax:
Mailing address:
  • Phone: 716-885-2261
  • Fax: 716-816-2547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074134-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: