Provider Demographics
NPI:1740020585
Name:BONILLA, CARLYN (LCSW)
Entity type:Individual
Prefix:
First Name:CARLYN
Middle Name:
Last Name:BONILLA
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 1:47-572 AHUIMANU RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5402
Mailing Address - Country:US
Mailing Address - Phone:808-366-2074
Mailing Address - Fax:
Practice Address - Street 1:47-572 AHUIMANU RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5402
Practice Address - Country:US
Practice Address - Phone:808-366-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-43981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical