Provider Demographics
NPI:1043004229
Name:BONILLA, LIZETTE (LCSW)
Entity type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:BONILLA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7042 DINWIDDIE ST # 8
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2003
Mailing Address - Country:US
Mailing Address - Phone:562-884-1767
Mailing Address - Fax:
Practice Address - Street 1:7042 DINWIDDIE ST # 8
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2003
Practice Address - Country:US
Practice Address - Phone:562-884-1767
Practice Address - Fax:562-884-1767
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical