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NPI Code Detail

MEDICARE: DEBRA BONNIWELL LCSW

MEDICARE:   DEBRA  BONNIWELL  LCSW
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 Worker0904003567VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386946648
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA BONNIWELL LCSW
Provider Business Mailing Address
First Line : 7985 MAIN ST
Second Line :
City : MIDDLETOWN
State : VA
Zip : 22645-9543
Country : US
Telephone Number : 540-868-1349
Fax Number :
Provider Business Practice Location Address
First Line : 7985 MAIN ST
Second Line :
City : MIDDLETOWN
State : VA
Zip : 22645-9543
Country : US
Telephone Number : 540-868-1349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2010
Last Update Date : 05/12/2012

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Directions to “ DEBRA BONNIWELL LCSW” Practice Location

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