Provider Demographics
NPI:1699947952
Name:LOSINGER-BONSERA, LAURA M (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:LOSINGER-BONSERA
Suffix:
Gender:F
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:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-0671
Mailing Address - Country:US
Mailing Address - Phone:631-334-8410
Mailing Address - Fax:
Practice Address - Street 1:368 VETERANS MEMORIAL HWY
Practice Address - Street 2:(SUITE 1)
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4322
Practice Address - Country:US
Practice Address - Phone:631-334-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-059832-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400001497OtherPTAN