Basic Information
| Provider Information | |||||||||
| NPI: | 1811041817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHWAST | ||||||||
| FirstName: | BONNIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | CROTON ON HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105202537 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | LINCOLN MEDICAL AND MENTAL HEALTH CENTER | ||||||||
| Address2: | 234 149TH STREET - 7B | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
| FaxNumber: | 7185799504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 012714 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.