Provider Demographics
NPI:1205033560
Name:ARLENE BONAPACE
Entity Type:Organization
Organization Name:ARLENE BONAPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONAPACE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-418-1122
Mailing Address - Street 1:764 EASTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1856
Mailing Address - Country:US
Mailing Address - Phone:732-418-1122
Mailing Address - Fax:732-937-8081
Practice Address - Street 1:764 EASTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1856
Practice Address - Country:US
Practice Address - Phone:732-418-1122
Practice Address - Fax:732-937-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00312000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1619002094OtherINDIVIDUAL NPI #
NJ406667Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID