Individual
BONITA MARIA BANTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
712 6TH ST NE, WASHINGTON, DC 20002-4324
(202) 546-9328
Mailing address
712 6TH ST NE, WASHINGTON, DC 20002-4324
(202) 546-9328
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC50077952
DC
Other
Enumeration date
10/03/2008
Last updated
09/30/2013
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