Fazio, Bonita E

Fazio, Bonita E is an sole proprietor health care provider with primary practice located at 297 Summer St Kingdom Recovery Center, St Johnsbury VT 05819-2283. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Fazio, Bonita E can be contacted via phone (802) 748-2524.

Contact Information

Primary practice address
297 Summer St Kingdom Recovery Center St Johnsbury VT 05819-2283
Phone: (802) 748-2524
Fax: (802) 748-2524
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 089-0001104 Vermont
Behavioral Health & Social Service Providers / Clinical 1041C0700X 1026261 Massachusetts

Profile Details

NPI number 1699826602
LBN Legal business name Fazio, Bonita E
Credentials LICSW
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 16th, 2007
Last updated Jun 6th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699826602 NPPES
Vermont MEDICAID 1013478

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