Provider Demographics
NPI:1497779193
Name:BONNY, ERICH L (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:ERICH
Middle Name:L
Last Name:BONNY
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 LIBERTY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6420
Mailing Address - Country:US
Mailing Address - Phone:410-552-0773
Mailing Address - Fax:410-552-0774
Practice Address - Street 1:1425 LIBERTY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6420
Practice Address - Country:US
Practice Address - Phone:410-552-0773
Practice Address - Fax:410-552-0774
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ866Medicare ID - Type UnspecifiedMEDICARE