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General NPI Number Information
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NPI Number | 1972960649
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Entity Type | Individual
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Provider Name | MICHELLE BONGIOVANNI MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 399 NW 2ND AVE
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City | BOCA RATON
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State | FL
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Zip | 33432-3845
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Country | US
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Telephone | 773-562-8655
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 880392
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City | BOCA RATON
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State | FL
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Zip | 33488-0392
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Country | US
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Telephone | 773-562-8655
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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 | 149.012152
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License Number State | IL
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