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General NPI Number Information
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NPI Number | 1548324882
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Entity Type | Individual
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Provider Name | LIZZETTE BONILLA SW- L.M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 657 CASTLETON AVE. SIMHS
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1408
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Country | US
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Telephone | 718-448-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 337 SOUTH AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-1408
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Country | US
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Telephone | 718-477-5054
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 069910
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License Number State | NY
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