Provider Demographics
NPI:1083234280
Name:BONESIO, RENA LUCILLE
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:LUCILLE
Last Name:BONESIO
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 1:2460 17TH AVE # 1127
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1860
Mailing Address - Country:US
Mailing Address - Phone:916-768-6889
Mailing Address - Fax:
Practice Address - Street 1:2460 17TH AVE # 1127
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1860
Practice Address - Country:US
Practice Address - Phone:916-768-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1221491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical