Basic Information
| Provider Information | |||||||||
| NPI: | 1376775825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOHNSACK | ||||||||
| FirstName: | MONIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2351 OLIVERA RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945201626 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2730 SALVIO ST | ||||||||
| Address2: | ALLIANCE HIGH SCHOOL | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945192599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256870374 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 59612 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.