Provider Demographics
NPI:1942773387
Name:BONILLA, RYANN (LCSW)
Entity Type:Individual
Prefix:
First Name:RYANN
Middle Name:
Last Name:BONILLA
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 1:164 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-3015
Mailing Address - Country:US
Mailing Address - Phone:508-386-7916
Mailing Address - Fax:
Practice Address - Street 1:201 ROCK ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3211
Practice Address - Country:US
Practice Address - Phone:508-823-9355
Practice Address - Fax:508-823-9357
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2225691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical