Provider Demographics
NPI:1871663302
Name:ATKINS, BONNIE L (LICSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:ATKINS
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:PO BOX 1184
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-5184
Mailing Address - Country:US
Mailing Address - Phone:413-376-4343
Mailing Address - Fax:413-774-4313
Practice Address - Street 1:278 MAIN ST STE 307A
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3230
Practice Address - Country:US
Practice Address - Phone:413-376-4343
Practice Address - Fax:413-774-4313
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10308421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08051OtherBLUE SHIELD
MAP08051OtherBLUE SHIELD