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General NPI Number Information
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NPI Number | 1609423128
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Entity Type | Individual
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Provider Name | LEANN BONNIE BORNEMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 1712 CHURCH ST
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City | HOLBROOK
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State | NY
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Zip | 11741
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Country | US
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Telephone | 631-880-5366
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Fax |
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Provider Business Mailing Address
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Address Line | 248 ROUTE 25A STE 3096
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City | EAST SETAUKET
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State | NY
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Zip | 11733-2954
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Country | US
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Telephone | 631-880-5366
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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 | 094879
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 109284
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License Number State | NY
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