Provider Demographics
NPI:1881252567
Name:BONIFACIC, ELAINE R (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:R
Last Name:BONIFACIC
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LANI
Other - Middle Name:
Other - Last Name:BONIFACIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:385 CLINTON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1934
Mailing Address - Country:US
Mailing Address - Phone:201-786-8572
Mailing Address - Fax:
Practice Address - Street 1:385 CLINTON AVE STE 2
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1934
Practice Address - Country:US
Practice Address - Phone:201-786-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054648001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical