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General NPI Number Information
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NPI Number | 1639260854
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Entity Type | Individual
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Provider Name | BONITA ANNE BANSKY-DONOVAN LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4513 VESTAL RD
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City | VESTAL
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State | NY
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Zip | 13850-3571
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Country | US
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Telephone | 607-760-3358
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Fax |
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Provider Business Mailing Address
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Address Line | 108 MURRAY ST
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City | BINGHAMTON
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State | NY
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Zip | 13905-3707
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Country | US
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Telephone | 607-723-4997
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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 | 054380-1 R
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License Number State | NY
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