Provider Demographics
NPI:1417454646
Name:LAURA BONINI LCSW, PLLC
Entity Type:Organization
Organization Name:LAURA BONINI LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BONINI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-389-1453
Mailing Address - Street 1:1207 DEWBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5124
Mailing Address - Country:US
Mailing Address - Phone:757-339-5558
Mailing Address - Fax:866-806-6123
Practice Address - Street 1:5660 E VIRGINIA BEACH BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2468
Practice Address - Country:US
Practice Address - Phone:757-389-1453
Practice Address - Fax:866-806-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA101568OtherMEDICARE NUMBER