Provider Demographics
NPI:1528497096
Name:BONAR, MICHAEL NICHOLAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NICHOLAS
Last Name:BONAR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BROADWAY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3458
Mailing Address - Country:US
Mailing Address - Phone:650-773-7146
Mailing Address - Fax:
Practice Address - Street 1:1425 BROADWAY
Practice Address - Street 2:SUITE 14
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3458
Practice Address - Country:US
Practice Address - Phone:650-773-7146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical