Healthcare Provider Details

I. General information

NPI: 1952607525
Provider Name (Legal Business Name): BONNIE JUNE HOLMES LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINDEN OAKS SUITE 200
ROCHESTER NY
14625-2840
US

IV. Provider business mailing address

315 MEIGS ST APT 1
ROCHESTER NY
14607-2412
US

V. Phone/Fax

Practice location:
  • Phone: 315-415-9939
  • Fax: 585-429-2800
Mailing address:
  • Phone: 315-415-9939
  • Fax: 585-429-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR072809-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: