Provider Demographics
NPI:1760490304
Name:CARR, BONNIE BETH (LISW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:BETH
Last Name:CARR
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44761
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-4761
Mailing Address - Country:US
Mailing Address - Phone:505-896-7880
Mailing Address - Fax:505-994-2482
Practice Address - Street 1:12 UNSER BLVD SE
Practice Address - Street 2:SUITE B
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6300
Practice Address - Country:US
Practice Address - Phone:505-896-7880
Practice Address - Fax:505-994-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI28761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI-2876OtherINDEPENDENT SOCIAL WORKER