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NPI Code Detail

MEDICARE: LAURA BONINI LCSW, PLLC

MEDICARE: LAURA BONINI LCSW, PLLC
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 Worker0904007040VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1VAA101568OTHERVAMEDICARE NUMBER

General Provider Information

NPI Number : 1417454646
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAURA BONINI LCSW, PLLC
Provider Business Mailing Address
First Line : 1207 DEWBERRY DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-5124
Country : US
Telephone Number : 757-339-5558
Fax Number : 866-806-6123
Provider Business Practice Location Address
First Line : 5660 E VIRGINIA BEACH BLVD STE 201
Second Line :
City : NORFOLK
State : VA
Zip : 23502-2468
Country : US
Telephone Number : 757-389-1453
Fax Number : 866-806-6123
Authorized Official
Title or Position : THERAPIST/OWNER
Name : LAURA ELIZABETH BONINI
Credential : LCSW
Telephone Number : 757-389-1453
Provider Enumeration Date : 04/13/2018
Last Update Date : 04/13/2018

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Directions to “LAURA BONINI LCSW, PLLC ” Practice Location

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