Provider Demographics
NPI:1477000800
Name:SUDOWSKI, BONNIE
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SUDOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 VIA D ESTE
Mailing Address - Street 2:UNIT 402
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3959
Mailing Address - Country:US
Mailing Address - Phone:860-235-5719
Mailing Address - Fax:
Practice Address - Street 1:116 VIA D ESTE
Practice Address - Street 2:UNIT 402
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3959
Practice Address - Country:US
Practice Address - Phone:860-235-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor