Provider Demographics
NPI:1942385497
Name:OWENS, BONNIE E (LCSW-R)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:E
Last Name:OWENS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WESTEND AVENUE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5243
Mailing Address - Country:US
Mailing Address - Phone:516-353-3022
Mailing Address - Fax:516-868-2591
Practice Address - Street 1:100 EAST OLD COUNTRY ROAD
Practice Address - Street 2:SUITE 15
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11510-4614
Practice Address - Country:US
Practice Address - Phone:516-353-3022
Practice Address - Fax:516-868-2591
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048687-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7341501OtherGHI/VALUE OPTIONS
NYP2576099OtherOXFORD HEALTH PLAN