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General NPI Number Information
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NPI Number | 1083088785
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Entity Type | Individual
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Provider Name | JENNIFER BONNEAU LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 25 W INDEPENDENCE WAY STE G
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City | KINGSTON
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State | RI
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Zip | 02881-1127
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Country | US
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Telephone | 401-789-4614
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Fax | 401-789-1957
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Provider Business Mailing Address
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Address Line | 25 W INDEPENDENCE WAY STE G
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City | KINGSTON
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State | RI
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Zip | 02881-1127
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Country | US
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Telephone | 401-789-4614
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Fax | 401-789-1957
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW02573
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License Number State | RI
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