Healthcare Provider Details

I. General information

NPI: 1265345896
Provider Name (Legal Business Name): SOCIOLOGYWORKS AT LARGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S 50TH ST
PHILADELPHIA PA
19139-3541
US

IV. Provider business mailing address

30 S 50TH ST
PHILADELPHIA PA
19139-3541
US

V. Phone/Fax

Practice location:
  • Phone: 347-587-9574
  • Fax:
Mailing address:
  • Phone: 347-587-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY B. BONNER
Title or Position: PROVIDER/OWNER
Credential: LCSW
Phone: 347-587-9574