Provider Demographics
NPI:1174826085
Name:BLECK, BONNIE LYN (MS,PD)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LYN
Last Name:BLECK
Suffix:
Gender:F
Credentials:MS,PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CLOVER DR
Mailing Address - Street 2:PUPIL PERSONNEL SERVICES-GREAT NECK PUBLIC SCHOOLS
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1031
Mailing Address - Country:US
Mailing Address - Phone:516-441-4970
Mailing Address - Fax:516-441-4270
Practice Address - Street 1:105 CLOVER DR
Practice Address - Street 2:PUPIL PERSONNEL SERVICES-GREAT NECK PUBLIC SCHOOLS
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1031
Practice Address - Country:US
Practice Address - Phone:516-441-4970
Practice Address - Fax:516-441-4270
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000038-1101YM0800X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health