Provider Demographics
NPI:1760765150
Name:O'BRIEN, BONNIE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ELIZABETH
Last Name:O'BRIEN
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 1:2431 BULLIS RD
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9239
Mailing Address - Country:US
Mailing Address - Phone:716-200-8873
Mailing Address - Fax:716-671-3191
Practice Address - Street 1:411 MAIN ST REAR
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1700
Practice Address - Country:US
Practice Address - Phone:716-200-8873
Practice Address - Fax:716-671-3191
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00091702Medicaid