Provider Demographics
NPI:1083916860
Name:BON, ANGELICA VICTORIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:VICTORIA
Last Name:BON
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 1:17542 17TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1960
Mailing Address - Country:US
Mailing Address - Phone:714-734-4500
Mailing Address - Fax:714-680-8207
Practice Address - Street 1:17542 17TH ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1959
Practice Address - Country:US
Practice Address - Phone:714-734-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA28821104100000X
CALCSW71706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker