Provider Demographics
NPI:1225504558
Name:BONAS, JASON (LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BONAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MADISON LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4409
Mailing Address - Country:US
Mailing Address - Phone:856-520-5647
Mailing Address - Fax:856-629-3405
Practice Address - Street 1:24 MADISON LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4409
Practice Address - Country:US
Practice Address - Phone:856-520-5647
Practice Address - Fax:856-629-3405
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00555700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health