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General NPI Number Information
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NPI Number | 1295325983
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Entity Type | Individual
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Provider Name | DONNA BONICATTO LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 6636 CEDAR AVE S STE 350
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City | RICHFIELD
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State | MN
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Zip | 55423-2712
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Country | US
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Telephone | 612-243-7989
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 2ND ST NE APT 214
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City | HOPKINS
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State | MN
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Zip | 55343-8355
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Country | US
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Telephone | 612-807-7618
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Fax |
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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 |
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License Number State |
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