Provider Demographics
NPI:1952645368
Name:BONOR, SUSAN M (MSW-CC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:BONOR
Suffix:
Gender:F
Credentials:MSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 WEEKS MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW SHARON
Mailing Address - State:ME
Mailing Address - Zip Code:04955
Mailing Address - Country:US
Mailing Address - Phone:207-778-9840
Mailing Address - Fax:
Practice Address - Street 1:284 MAIN STREET, SUITE 210
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-3044
Practice Address - Country:US
Practice Address - Phone:207-645-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC130171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical