Individual
MS. BONITA S. WAYLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW R
Contact information
Practice address
57 E FULTON ST, GLOVERSVILLE, NY 12078-3212
(518) 773-3531
(518) 773-9103
Mailing address
177 SACANDAGA RD, JOHNSTOWN, NY 12095-3787
(518) 762-6704
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
R053562-1
NY
Other
Enumeration date
05/18/2006
Last updated
07/23/2013
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