Katherine I Bonilla, LMSW, LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

010124 Issued in CT

Practice address

872 Main St
Willimantic, CT 06226-2342

Phone

(860) 985-3494

NPI assigned

Sep 12, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of Connecticut

  • Psychiatric Hospital
  • Hartford, CT
  • NPI 1487689022

  CT

  Medicare reassignment NPD
• State of Connecticut

  • Skilled Nursing Facility
  • Rocky Hill, CT
  • NPI 1205951662
  NPD

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

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1740530336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 ASHFORD LAKE DR",
            "city": "ASHFORD",
            "state": "CT",
            "postal_code": "062781201",
            "telephone_number": "860-646-3888",
            "fax_number": "860-645-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 MAIN ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262342",
            "telephone_number": "860-985-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "KATHERINE",
        "middle_name": "I",
        "name_prefix": "Mrs.",
        "credential": "LMSW, LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-12",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "010124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASTER'S LEVEL SOCIAL WORKER",
            "identifier": "001366",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janna Blackstone, LCSW
• Martin Adam Bloch, MD
• Melissa Bohan-Hallenbeck, APRN
• Athena Bolinger
• Bevan P Bonhomme, MD
• Breanna Mona Bostick
• Jason Andrew Boucher, LMFT
• Julie A. Bousquet, OT
• Fran Ia Bowen, RN
• Anna Bratz

• All providers in Willimantic, CT
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.