Provider Demographics
NPI:1528489630
Name:BENNETT, BONNIE J (LMSW)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:J
Other - Last Name:VINTON-STUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5031 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-565-4820
Mailing Address - Fax:845-565-4884
Practice Address - Street 1:5031 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-565-4824
Practice Address - Fax:845-565-4884
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060040-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker