Provider Demographics
NPI:1548324882
Name:BONILLA, LIZZETTE (SW- LMSW)
Entity type:Individual
Prefix:MS
First Name:LIZZETTE
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:SW- LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1408
Mailing Address - Country:US
Mailing Address - Phone:718-477-5054
Mailing Address - Fax:
Practice Address - Street 1:657 CASTLETON AVE.
Practice Address - Street 2:SIMHS
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1408
Practice Address - Country:US
Practice Address - Phone:718-448-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069910104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker