MEDICARE: BONNIE CASEY QUINTON L.C.S.W.

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	LCS9202	CA

General Provider Information

NPI Number	:	1518953512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE CASEY QUINTON L.C.S.W.

Provider Business Mailing Address
First Line	:	2460 N PONDEROSA DR
Second Line	:	SUITE A-110
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2375
Country	:	US
Telephone Number	:	805-384-9399
Fax Number	:	805-384-9388

Provider Business Practice Location Address
First Line	:	2460 N PONDEROSA DR
Second Line	:	SUITE A-110
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2375
Country	:	US
Telephone Number	:	805-384-9399
Fax Number	:	805-384-9388

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

Provider Enumeration Date	:	09/25/2005
Last Update Date	:	07/08/2007

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