Provider Demographics
NPI:1003953787
Name:BONNEY, LAUREL A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:A
Last Name:BONNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MILL PLAIN RD FL 3
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5178
Mailing Address - Country:US
Mailing Address - Phone:203-546-3414
Mailing Address - Fax:203-546-3455
Practice Address - Street 1:100 MILL PLAIN RD FL 3
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5178
Practice Address - Country:US
Practice Address - Phone:203-546-3414
Practice Address - Fax:203-546-3455
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040051611041C0700X
NY730783361041C0700X
CT100761041C0700X
FLSW122631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010037328Medicaid