Provider Demographics
NPI:1699182428
Name:BONNEY, STELLAMARIS (MSW)
Entity Type:Individual
Prefix:
First Name:STELLAMARIS
Middle Name:
Last Name:BONNEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 E RUTLAND VLG
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5511
Mailing Address - Country:US
Mailing Address - Phone:512-906-5295
Mailing Address - Fax:
Practice Address - Street 1:10005 E RUTLAND VLG
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5511
Practice Address - Country:US
Practice Address - Phone:512-906-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator