Provider Demographics
NPI:1619747805
Name:BONGIOVANNI, ZOE DEMARE-WYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:DEMARE-WYNNE
Last Name:BONGIOVANNI
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 1:7 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3424
Mailing Address - Country:US
Mailing Address - Phone:484-744-6300
Mailing Address - Fax:
Practice Address - Street 1:7 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3424
Practice Address - Country:US
Practice Address - Phone:484-744-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061421001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty