Provider Demographics
NPI:1700096229
Name:ULLMAN, BONITA KRASNER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:KRASNER
Last Name:ULLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1030
Mailing Address - Country:US
Mailing Address - Phone:718-854-1996
Mailing Address - Fax:
Practice Address - Street 1:310 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1030
Practice Address - Country:US
Practice Address - Phone:718-854-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0135331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical