Provider Demographics
NPI:1972606044
Name:KAUDER, BONNIE C (LCSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:C
Last Name:KAUDER
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269-10 GRAND CENTRAL PARKWAY
Mailing Address - Street 2:APT. 3U
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11005-1003
Mailing Address - Country:US
Mailing Address - Phone:718-225-0821
Mailing Address - Fax:
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:SUITE PH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-848-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5078101YA0400X
NYR03687511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS05306Medicare UPIN
NYNOM251Medicare ID - Type UnspecifiedQUEENS COUNTY