Provider Demographics
NPI:1518238906
Name:BONNER, ELIZABETH KATHLEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHLEEN
Last Name:BONNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KATHLEEN
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1850
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-8629
Mailing Address - Country:US
Mailing Address - Phone:631-403-6509
Mailing Address - Fax:
Practice Address - Street 1:701 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8894
Practice Address - Country:US
Practice Address - Phone:516-403-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0860131041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical