Provider Demographics
NPI:1346586260
Name:BONIFACIO, CAMILLE LAGMAN (COUNSELOR)
Entity Type:Individual
Prefix:MISS
First Name:CAMILLE
Middle Name:LAGMAN
Last Name:BONIFACIO
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4708
Mailing Address - Country:US
Mailing Address - Phone:562-433-0454
Mailing Address - Fax:562-433-0545
Practice Address - Street 1:2703 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4708
Practice Address - Country:US
Practice Address - Phone:562-433-0454
Practice Address - Fax:562-433-0545
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)