Provider Demographics
NPI:1376726976
Name:SCHOENBACH, BONNI G (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:BONNI
Middle Name:G
Last Name:SCHOENBACH
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 1:371 MERRICK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5359
Mailing Address - Country:US
Mailing Address - Phone:516-766-7632
Mailing Address - Fax:516-764-7235
Practice Address - Street 1:371 MERRICK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5359
Practice Address - Country:US
Practice Address - Phone:516-766-7632
Practice Address - Fax:516-764-7235
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0518571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS25808Medicare UPIN
NYN9G901Medicare PIN