Provider Demographics
NPI:1063283307
Name:BONGIORNO, ROBBIN LYNDA
Entity type:Individual
Prefix:
First Name:ROBBIN
Middle Name:LYNDA
Last Name:BONGIORNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CANAAN CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-2519
Mailing Address - Country:US
Mailing Address - Phone:914-299-6032
Mailing Address - Fax:
Practice Address - Street 1:14 CANAAN CIR
Practice Address - Street 2:
Practice Address - City:SOUTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10590-2519
Practice Address - Country:US
Practice Address - Phone:914-299-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0710041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical