Provider Demographics
NPI:1568042323
Name:MCINTYRE, BONNIE LYNN (PHD, LICSW, LCSW-C)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYNN
Last Name:MCINTYRE
Suffix:
Gender:
Credentials:PHD, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 VERMONT AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4905
Mailing Address - Country:US
Mailing Address - Phone:415-360-3833
Mailing Address - Fax:
Practice Address - Street 1:1090 VERMONT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4905
Practice Address - Country:US
Practice Address - Phone:415-360-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0255661041C0700X
VA09040173591041C0700X
MD326941041C0700X
DCLC2000025381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical