MEDICARE: DEIDRE BONARRIGO 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
1	1041C0700X	Clinical Social Worker	LC22240	ME
2	1041C0700X	Clinical Social Worker	44SC06240400	NJ
3	1041C0700X	Clinical Social Worker	SW12027	FL
4	1041C0700X	Clinical Social Worker	081413-1	NY
5	1041C0700X	Clinical Social Worker	33116	MN

General Provider Information

NPI Number	:	1396092458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRE BONARRIGO LCSW

Provider Business Mailing Address
First Line	:	PO BOX 5436
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-5436
Country	:	US
Telephone Number	:	315-451-4076
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 DOLORES TER N
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-3503
Country	:	US
Telephone Number	:	315-451-4076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2012
Last Update Date	:	03/21/2024

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