Doctor Name: | DESLIE BONANO |
NPI Number: | 1255340501 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW, BCD |
License Number: | C6126 |
Business Practice Address: | 703 W Canal St Picayune, MS - 394663918 |
Business Phone Number: | 6017499477 |
Business Fax Number: | 6018891265 |
Mailing Address: | 703 W Canal St, PICAYUNE |
State: | MS |
Postal Code: | 394663918 |
Phone Number: | 6017499477 |
Fax Number: | 6018891265 |
NPI Enumeration Date: | 08/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | C6126 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |