Provider Demographics
NPI:1699750646
Name:BONDS-HARMON, HEATHER ALLISON (LICSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALLISON
Last Name:BONDS-HARMON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SPOKANE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1311
Mailing Address - Country:US
Mailing Address - Phone:401-369-3911
Mailing Address - Fax:401-310-0502
Practice Address - Street 1:750 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6165
Practice Address - Country:US
Practice Address - Phone:401-369-3911
Practice Address - Fax:401-337-5335
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW016301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412286OtherBLUE CHIP
RIHB55479Medicaid
RI29268-1OtherBLUE CROSS
RI29268-1OtherBLUE CROSS