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NPI Code Detail

MEDICARE: BONNIE WATTS MOONEY LISW-CP

MEDICARE: BONNIE WATTS MOONEY LISW-CP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker004608SC

General Provider Information

NPI Number : 1033135553
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE WATTS MOONEY LISW-CP
Provider Business Mailing Address
First Line : 301A PALMETTO PARK BLVD
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-7872
Country : US
Telephone Number : 803-359-3545
Fax Number : 803-359-2111
Provider Business Practice Location Address
First Line : 301A PALMETTO PARK BLVD
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-7872
Country : US
Telephone Number : 803-359-3545
Fax Number : 803-359-2111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 01/27/2012

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Directions to “ BONNIE WATTS MOONEY LISW-CP” Practice Location

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