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NPI Code Detail

MEDICARE: MS. ELIZABETH RITA BONUCK LCSW

MEDICARE: MS. ELIZABETH RITA BONUCK 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 Worker076263NY

General Provider Information

NPI Number : 1528163755
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH RITA BONUCK LCSW
Provider Business Mailing Address
First Line : 3206 VITTORIA AVE
Second Line :
City : HENDERSON
State : NV
Zip : 89044-1819
Country : US
Telephone Number : 631-428-2612
Fax Number :
Provider Business Practice Location Address
First Line : 4461 E CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-5537
Country : US
Telephone Number : 702-291-9050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 07/12/2024

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