Provider Demographics
NPI:1790051852
Name:BONCZEK, LAURA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:BONCZEK
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 1:150 NW 168TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6034
Mailing Address - Country:US
Mailing Address - Phone:877-723-7117
Mailing Address - Fax:
Practice Address - Street 1:150 NW 168TH ST STE 200
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6034
Practice Address - Country:US
Practice Address - Phone:877-723-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW141091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical