Provider Demographics
NPI:1174794036
Name:COLE, BONNIE L
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:881 FEDERAL FURNACE RD
Mailing Address - Street 2:PO BOX 1227
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4745
Mailing Address - Country:US
Mailing Address - Phone:617-688-0847
Mailing Address - Fax:
Practice Address - Street 1:881 FEDERAL FURNACE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4745
Practice Address - Country:US
Practice Address - Phone:617-688-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health