Provider Demographics
NPI:1225608102
Name:BONCZAR, JESSICA L (LMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:BONCZAR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-0025
Mailing Address - Country:US
Mailing Address - Phone:716-697-2946
Mailing Address - Fax:
Practice Address - Street 1:162 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4917
Practice Address - Country:US
Practice Address - Phone:716-697-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007098-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health