Provider Demographics
NPI:1740328038
Name:BONFILS-ROBERTS, ELENA ROSA (LMSW)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:ROSA
Last Name:BONFILS-ROBERTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 E 80TH ST APT 14A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0469
Mailing Address - Country:US
Mailing Address - Phone:212-517-7564
Mailing Address - Fax:718-206-7083
Practice Address - Street 1:178 E 80TH ST APT 14A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0469
Practice Address - Country:US
Practice Address - Phone:212-517-7564
Practice Address - Fax:718-206-7083
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052935-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker