Provider Demographics
NPI:1942371091
Name:KAMEN, BONNIE B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:B
Last Name:KAMEN
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:P.O. BOX 10
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:NY
Mailing Address - Zip Code:11957-0010
Mailing Address - Country:US
Mailing Address - Phone:631-323-9775
Mailing Address - Fax:631-323-8050
Practice Address - Street 1:885 PARK AVE.
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0383
Practice Address - Country:US
Practice Address - Phone:212-737-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO14987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY886389632OtherNASWMEMBERSHIP
NY8686OtherABECSW
NYRO14987OtherNYS CLINICAL PROVIDER #