Provider Demographics
NPI:1306672605
Name:BONUITO, KRISTIN SUSANNE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SUSANNE
Last Name:BONUITO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-3449
Mailing Address - Country:US
Mailing Address - Phone:412-480-6219
Mailing Address - Fax:
Practice Address - Street 1:5180 CAMPBELLS RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9731
Practice Address - Country:US
Practice Address - Phone:412-480-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SW133035101YM0800X
PASW133035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health