Provider Demographics
NPI:1215927157
Name:BONIER, CAROLYN MALONE (LICSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:MALONE
Last Name:BONIER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1802
Mailing Address - Country:US
Mailing Address - Phone:978-475-2182
Mailing Address - Fax:
Practice Address - Street 1:10 ESSEX ST
Practice Address - Street 2:SUITE 7
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3727
Practice Address - Country:US
Practice Address - Phone:978-475-2182
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical