Provider Demographics
NPI:1518953512
Name:QUINTON, BONNIE CASEY (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:CASEY
Last Name:QUINTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 N PONDEROSA DR
Mailing Address - Street 2:SUITE A-110
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2375
Mailing Address - Country:US
Mailing Address - Phone:805-384-9399
Mailing Address - Fax:805-384-9388
Practice Address - Street 1:2460 N PONDEROSA DR
Practice Address - Street 2:SUITE A-110
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2375
Practice Address - Country:US
Practice Address - Phone:805-384-9399
Practice Address - Fax:805-384-9388
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS92021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW9202Medicare ID - Type Unspecified