Provider Demographics
NPI:1063425684
Name:BUDMAN, BONNIE (LCSW)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BUDMAN
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 1:15 SEALY CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2411
Mailing Address - Country:US
Mailing Address - Phone:516-295-1295
Mailing Address - Fax:
Practice Address - Street 1:15 SEALY CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-2411
Practice Address - Country:US
Practice Address - Phone:516-295-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0697671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4740DXMedicare ID - Type Unspecified