Provider Demographics
NPI:1306855440
Name:MAUTE, BONNIE D (LCSW CEAP SAP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:D
Last Name:MAUTE
Suffix:
Gender:F
Credentials:LCSW CEAP SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 CLINE RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564
Mailing Address - Country:US
Mailing Address - Phone:585-704-2775
Mailing Address - Fax:505-924-9054
Practice Address - Street 1:100 CROSS KEYS OFFICE PARK STE 115
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3509
Practice Address - Country:US
Practice Address - Phone:585-704-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04563511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0780Medicare ID - Type Unspecified