Provider Demographics
NPI:1922152529
Name:BONERBO, CHARLES A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:BONERBO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 WEBSTER AVE
Mailing Address - Street 2:APT 1F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-2358
Mailing Address - Country:US
Mailing Address - Phone:917-539-2032
Mailing Address - Fax:
Practice Address - Street 1:168 W 86TH ST
Practice Address - Street 2:SUITE 1 D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4022
Practice Address - Country:US
Practice Address - Phone:917-539-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-039863-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical