Provider Demographics
NPI:1083483853
Name:BONITATIS, NOELLE ANNE
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:ANNE
Last Name:BONITATIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CASEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6111
Mailing Address - Country:US
Mailing Address - Phone:570-831-9292
Mailing Address - Fax:
Practice Address - Street 1:116 LARCH ST FL 3
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2802
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health