Provider Demographics
NPI:1689997934
Name:CRAEMER, BONNIE PETRIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:PETRIE
Last Name:CRAEMER
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 1:114 SADDLEHORN CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2055
Mailing Address - Country:US
Mailing Address - Phone:954-695-0460
Mailing Address - Fax:
Practice Address - Street 1:114 SADDLEHORN CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2055
Practice Address - Country:US
Practice Address - Phone:954-695-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0057271041C0700X
FLSW93671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical