Provider Demographics
NPI:1851481667
Name:CONWAY, BONITA LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:LOUISE
Last Name:CONWAY
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 1:21217 WINDSONG CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2075
Mailing Address - Country:US
Mailing Address - Phone:909-598-3327
Mailing Address - Fax:
Practice Address - Street 1:21217 WINDSONG CIR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2075
Practice Address - Country:US
Practice Address - Phone:909-598-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical