Provider Demographics
NPI:1497039192
Name:BONZON, TEODULO CRUZ (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TEODULO
Middle Name:CRUZ
Last Name:BONZON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9405
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91226-0405
Mailing Address - Country:US
Mailing Address - Phone:818-846-4469
Mailing Address - Fax:
Practice Address - Street 1:3013 ANNITA DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-1302
Practice Address - Country:US
Practice Address - Phone:818-846-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS196461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical