Provider Demographics
NPI:1265602650
Name:BONITATIBUS, ELAINE-MARIE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:ELAINE-MARIE
Middle Name:
Last Name:BONITATIBUS
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:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-0102
Mailing Address - Country:US
Mailing Address - Phone:336-486-7971
Mailing Address - Fax:
Practice Address - Street 1:147 MONT VERNON RD
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:NH
Practice Address - Zip Code:03070-3900
Practice Address - Country:US
Practice Address - Phone:603-213-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16281041C0700X
MA1210801041C0700X
NCC00655571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical