Provider Demographics
NPI:1952607525
Name:HOLMES, BONNIE JUNE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JUNE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MEIGS ST
Mailing Address - Street 2:APT 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2412
Mailing Address - Country:US
Mailing Address - Phone:315-415-9939
Mailing Address - Fax:585-429-2800
Practice Address - Street 1:100 LINDEN OAKS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2840
Practice Address - Country:US
Practice Address - Phone:315-415-9939
Practice Address - Fax:585-429-2800
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR072809-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical