Provider Demographics
NPI:1215022991
Name:HANCOCK, BONNIE (MSS, LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1710
Mailing Address - Country:US
Mailing Address - Phone:610-777-9991
Mailing Address - Fax:610-777-9991
Practice Address - Street 1:1328 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-1710
Practice Address - Country:US
Practice Address - Phone:610-777-9991
Practice Address - Fax:610-777-9996
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000329L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA634021Medicare ID - Type Unspecified