Provider Demographics
NPI:1437299690
Name:WEINTRAUB, BONNIE G (CSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:G
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 SUMMER DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2780
Mailing Address - Country:US
Mailing Address - Phone:516-679-5878
Mailing Address - Fax:516-679-5878
Practice Address - Street 1:627 BROADWAY
Practice Address - Street 2:STE.200
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5031
Practice Address - Country:US
Practice Address - Phone:516-221-4354
Practice Address - Fax:516-221-4354
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032557-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7402636OtherBEHAVIORAL HEALTH PROVIDE
NYP75993OtherBEHAVIORAL HEALTH PROVIDE
NYP75993OtherBEHAVIORAL HEALTH PROVIDE