Provider Demographics
NPI:1538297338
Name:MEYERSON, BONNIE W (LCSW)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:W
Last Name:MEYERSON
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 1:5252 AGNES AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2745
Mailing Address - Country:US
Mailing Address - Phone:818-762-8536
Mailing Address - Fax:
Practice Address - Street 1:6838 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-7008
Practice Address - Country:US
Practice Address - Phone:323-461-3161
Practice Address - Fax:323-461-5683
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 65621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical