Provider Demographics
NPI:1265506471
Name:COLLINS, BONNIE J (EDM LCSWR)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:F
Credentials:EDM LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075
Mailing Address - Country:US
Mailing Address - Phone:716-648-4455
Mailing Address - Fax:716-648-2760
Practice Address - Street 1:162 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075
Practice Address - Country:US
Practice Address - Phone:716-648-4455
Practice Address - Fax:716-648-2760
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0242401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000503599001OtherBLUE CROSS & BLUE SHIELD
NY000503599001OtherBLUE CROSS & BLUE SHIELD