Bonnie Yezukevich, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

115337 Issued in MA

Practice address

1920 Centre St
West Roxbury, MA 02132-2513

Phone

(617) 694-5201

NPI assigned

Sep 28, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1407331176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 N WORCESTER ST",
            "city": "NORTON",
            "state": "MA",
            "postal_code": "027662046",
            "telephone_number": "617-694-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 CENTRE ST",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021322513",
            "telephone_number": "617-694-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEZUKEVICH",
        "first_name": "BONNIE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "115337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Brian Woolley, PHARM.D.
• Mona Shiao Wu, MD
• Huihong Xu, M.D.
• Michael B Yaffe, M.D.
• Subbarao Venkata Yalla, M.D
• Amerlie Yi
• Allan W Yiu, BSC
• Sue Hae Sook Yoon, NP
• Ai Lin Yu
• Hongbo Yu, MD

• Clinical Social Worker in West Roxbury, MA
• Providers in West Roxbury, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.