Provider Demographics
NPI:1275033128
Name:BONNY-RANKIN, SORAYA MARIE
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:MARIE
Last Name:BONNY-RANKIN
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 1:126 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1313
Mailing Address - Country:US
Mailing Address - Phone:516-379-0876
Mailing Address - Fax:
Practice Address - Street 1:126 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1313
Practice Address - Country:US
Practice Address - Phone:516-379-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072591104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker