Provider Demographics
NPI:1003210303
Name:BONNIE K. SCRANTON MSW LLC
Entity Type:Organization
Organization Name:BONNIE K. SCRANTON MSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRANTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-878-8142
Mailing Address - Street 1:682 FERN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1420
Mailing Address - Country:US
Mailing Address - Phone:860-878-8142
Mailing Address - Fax:860-242-1476
Practice Address - Street 1:45 WINTONBURY AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2470
Practice Address - Country:US
Practice Address - Phone:860-878-8142
Practice Address - Fax:860-242-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0074031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty