Provider Demographics
NPI:1346345691
Name:BONIELLO, MICHAEL JOSEPH (LSCSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BONIELLO
Suffix:
Gender:M
Credentials:LSCSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W 75TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3502
Mailing Address - Country:US
Mailing Address - Phone:913-384-6542
Mailing Address - Fax:913-384-4629
Practice Address - Street 1:1900 W 75TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3502
Practice Address - Country:US
Practice Address - Phone:913-384-6542
Practice Address - Fax:913-384-4629
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW #8911041C0700X
MOLCSW #15481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0002365Medicare ID - Type Unspecified