Provider Demographics
NPI:1154485274
Name:DE BONIS, NICOLE B (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:DE BONIS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE BETHANY ROAD
Mailing Address - Street 2:SUITE 34 INSTITUTE FOR PSYCHOLOGICAL & SPIRITUAL GROWTH
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730
Mailing Address - Country:US
Mailing Address - Phone:732-739-4098
Mailing Address - Fax:
Practice Address - Street 1:ONE BETHANY ROAD
Practice Address - Street 2:SUITE 34 INSTITUTE FOR PSYCHOLOGICAL & SPIRITUAL GROWTH
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730
Practice Address - Country:US
Practice Address - Phone:732-739-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000222001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P442571OtherOXFORD INS CO
P442571OtherOXFORD INS CO