Provider Demographics
NPI:1639545635
Name:BONSIERO, KIMBERLY (LCSW-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BONSIERO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BEEHIVE PL APT D
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3738
Mailing Address - Country:US
Mailing Address - Phone:410-404-6982
Mailing Address - Fax:
Practice Address - Street 1:2117 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5614
Practice Address - Country:US
Practice Address - Phone:410-404-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD221481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521362793OtherUNIVERSITY OF MARYLAND MEDICAL CENTER