=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225394158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER BUONO LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2012
-----------------------------------------------------
Last Update Date | 10/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 731 SAW MILL RIVER RD STE 7
-----------------------------------------------------
City | ARDSLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10502-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-608-0348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 GEDNEY ST APT LN
-----------------------------------------------------
City | NYACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10960-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-608-0348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 084126
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 088659-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------