Provider Demographics
NPI:1649386756
Name:BONILLA, ANDREA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:BOROVEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1914
Mailing Address - Country:US
Mailing Address - Phone:845-354-1497
Mailing Address - Fax:
Practice Address - Street 1:971 ROUTE 45
Practice Address - Street 2:SUITE 116
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3500
Practice Address - Country:US
Practice Address - Phone:845-354-9200
Practice Address - Fax:845-354-8555
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical