Provider Demographics
NPI:1609186048
Name:MCCREDIE, BONNIE FRANCES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:FRANCES
Last Name:MCCREDIE
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 1:2207 S CAROLINA AVE
Mailing Address - Street 2:#28
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6290
Mailing Address - Country:US
Mailing Address - Phone:813-943-7041
Mailing Address - Fax:
Practice Address - Street 1:1308 W SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5902
Practice Address - Country:US
Practice Address - Phone:813-375-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW31791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical