Provider Demographics
NPI:1629597356
Name:BONIN, BRUCE E (LCSW)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:BONIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-602-7817
Mailing Address - Fax:719-597-4534
Practice Address - Street 1:2125 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1507
Practice Address - Country:US
Practice Address - Phone:719-602-7817
Practice Address - Fax:719-597-4534
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099265801041C0700X
COLSW.0009920735104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical