Individual
MS. BONITA E FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
297 SUMMER ST, KINGDOM RECOVERY CENTER, ST JOHNSBURY, VT 05819-2283
(802) 748-2524
(802) 748-2524
Mailing address
PO BOX 152, ST JOHNSBURY, VT 05819-0152
(802) 748-2524
(802) 748-2524
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089-0001104
VT
1041C0700X
Clinical Social Worker
1026261
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013478
—
VT
Enumeration date
01/16/2007
Last updated
06/06/2008
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