Provider Demographics
NPI:1447666193
Name:WRIGHT, BONNIE (LCSW-C)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:M
Other - Last Name:TRIANTAFILLOS-WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1179 AVONDALE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3965
Mailing Address - Country:US
Mailing Address - Phone:301-698-2589
Mailing Address - Fax:
Practice Address - Street 1:5229 NEW DESIGN RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7103
Practice Address - Country:US
Practice Address - Phone:301-524-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical