Provider Demographics
NPI:1578008603
Name:LINNICK, BONNIE (MED)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:LINNICK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:500 PECONIC ST
Mailing Address - Street 2:APT 195A
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7100
Mailing Address - Country:US
Mailing Address - Phone:631-295-6333
Mailing Address - Fax:
Practice Address - Street 1:500 PECONIC ST
Practice Address - Street 2:APT 195A
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7100
Practice Address - Country:US
Practice Address - Phone:631-295-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician