Active NPI
Bonita Maria Bantom, LICSW
- Clinical Social Worker
- Washington, DC
National Provider Identifier
1295986628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC50077952
- Practice address
- 712 6TH St NE
Washington, DC 20002-4324 - Phone
- (202) 546-9328
- NPI assigned
- Oct 3, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC50077952 | DC | Primary |
Addresses
Primary practice location
712 6TH St NE
Washington, DC 20002-4324
Mailing address
712 6TH St NE
Washington, DC 20002-4324
Phone (202) 546-9328
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC50077952 | DC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380499200000",
"number": "1295986628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 6TH ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200024324",
"telephone_number": "202-546-9328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 6TH ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200024324",
"telephone_number": "202-546-9328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANTOM",
"first_name": "BONITA",
"middle_name": "MARIA",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-03",
"last_updated": "2013-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC50077952",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.