Provider Demographics
NPI:1386657963
Name:HALEY, BONNIE D (LCSW R)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:D
Last Name:HALEY
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 1:19 ZENITH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8844
Mailing Address - Country:US
Mailing Address - Phone:631-744-7009
Mailing Address - Fax:
Practice Address - Street 1:19 ZENITH RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8844
Practice Address - Country:US
Practice Address - Phone:631-744-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0694911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical