Provider Demographics
NPI:1760065569
Name:COURTEMANCHE, BONNIE ROBINSON (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ROBINSON
Last Name:COURTEMANCHE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1910
Mailing Address - Country:US
Mailing Address - Phone:978-513-7273
Mailing Address - Fax:781-268-5070
Practice Address - Street 1:166 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1910
Practice Address - Country:US
Practice Address - Phone:978-513-7273
Practice Address - Fax:781-268-5070
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1264761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA126476OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER