Healthcare Provider Details

I. General information

NPI: 1508917568
Provider Name (Legal Business Name): LAURA SUSAN BOND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
DANSVILLE NY
14437-1709
US

IV. Provider business mailing address

2504 DUTCH HOLLOW RD
AVON NY
14414-9713
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax:
Mailing address:
  • Phone: 585-226-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: