Provider Demographics
NPI:1124086046
Name:BONILLA, ALLISON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:BONILLA
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 1:2425 S VOLUSIA AVE
Mailing Address - Street 2:STE B-4
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7625
Mailing Address - Country:US
Mailing Address - Phone:386-774-1330
Mailing Address - Fax:888-808-2088
Practice Address - Street 1:2425 S VOLUSIA AVE
Practice Address - Street 2:SUITE B-4
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7625
Practice Address - Country:US
Practice Address - Phone:386-774-1330
Practice Address - Fax:888-808-2088
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 035440104100000X
FLSW42601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7248Medicare ID - Type UnspecifiedPROVIDER NUMBER