Provider Demographics
NPI:1083234280
Name:BONESIO, RENA LUCILLE
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:LUCILLE
Last Name:BONESIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8133
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-8133
Mailing Address - Country:US
Mailing Address - Phone:916-768-6889
Mailing Address - Fax:
Practice Address - Street 1:1430 BLUE OAKS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5156
Practice Address - Country:US
Practice Address - Phone:661-750-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW858931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical