Provider Demographics
NPI:1205996279
Name:BONNEAU, NICOLE DIANE (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:DIANE
Last Name:BONNEAU
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2973
Mailing Address - Country:US
Mailing Address - Phone:781-942-9277
Mailing Address - Fax:
Practice Address - Street 1:36 WOBURN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2973
Practice Address - Country:US
Practice Address - Phone:781-942-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA425199101YS0200X
MA114103101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool