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General NPI Number Information
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NPI Number | 1417454646
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Entity Type | Organization
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Legal Business Name | LAURA BONINI LCSW, PLLC
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 5660 E VIRGINIA BEACH BLVD STE 201
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City | NORFOLK
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State | VA
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Zip | 23502-2468
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Country | US
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Telephone | 757-389-1453
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Fax | 866-806-6123
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Provider Business Mailing Address
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Address Line | 1207 DEWBERRY DR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5124
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Country | US
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Telephone | 757-339-5558
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Fax | 866-806-6123
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | LAURA ELIZABETH BONINI
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Credential | LCSW
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Telephone | 757-389-1453
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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 | 0904007040
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License Number State | VA
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