MEDICARE: MS. DENISE ANN BONDY LCSW-R

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	R042588-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	192729FK	OTHER	NY	PREFERRED CARE PROVIDER #
2	P010042588	OTHER	NY	EXCELLUS PIN #

General Provider Information

NPI Number	:	1477608586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE ANN BONDY LCSW-R

Provider Business Mailing Address
First Line	:	99 HOLLYVALE DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2815
Country	:	US
Telephone Number	:	585-355-9960
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 ALLENS CREEK RD STE 216
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3250
Country	:	US
Telephone Number	:	585-355-9960
Fax Number	:	585-377-3553

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	12/12/2023

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