Provider Demographics
NPI:1275633067
Name:BRONSON, VIRGINIA ANNE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANNE
Last Name:BRONSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HEATH DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-5435
Mailing Address - Country:US
Mailing Address - Phone:607-427-9382
Mailing Address - Fax:607-729-6434
Practice Address - Street 1:4513 OLD VESTAL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3571
Practice Address - Country:US
Practice Address - Phone:607-427-9382
Practice Address - Fax:607-729-6434
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048042-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048042-1OtherLCSW