Provider Demographics
NPI:1295325983
Name:BONICATTO, DONNA (LICSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BONICATTO
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 1:1111 2ND ST NE APT 214
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8355
Mailing Address - Country:US
Mailing Address - Phone:612-807-7618
Mailing Address - Fax:
Practice Address - Street 1:6636 CEDAR AVE S STE 350
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2712
Practice Address - Country:US
Practice Address - Phone:612-243-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical