Provider Demographics
NPI:1902520158
Name:BONILLA, ADRIANA (LCSW)
Entity Type:Individual
Prefix:
First Name:ADRIANA
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 1:410 HIDDEN TRAILS RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-5333
Mailing Address - Country:US
Mailing Address - Phone:760-291-2257
Mailing Address - Fax:760-741-7605
Practice Address - Street 1:410 HIDDEN TRAILS RD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-5333
Practice Address - Country:US
Practice Address - Phone:760-291-2257
Practice Address - Fax:760-741-7605
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW947141041C0700X, 1041S0200X
COLCSW94714251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251B00000XAgenciesCase Management