Provider Demographics
NPI:1346345303
Name:GERSHENZON, BONNIE E (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:E
Last Name:GERSHENZON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 VANTAGE LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1366
Mailing Address - Country:US
Mailing Address - Phone:847-480-9671
Mailing Address - Fax:847-480-9643
Practice Address - Street 1:3411 VANTAGE LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1366
Practice Address - Country:US
Practice Address - Phone:847-480-9671
Practice Address - Fax:847-480-9643
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical