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Individual

MS. BRENDA BONUCCELLI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
14 S AUBURN AVE, RICHMOND, VA 23221-2910
(804) 402-0429
Mailing address
14 S AUBURN AVE, RICHMOND, VA 23221-2910
(804) 402-0429

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006655
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
463000281
VA
01
Q463000281
MEDICARE
VA
Enumeration date
09/13/2007
Last updated
05/30/2023
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