Provider Demographics
NPI:1326090986
Name:CARPENTER, BONNIE SUE (EDD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:SUE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1918
Mailing Address - Country:US
Mailing Address - Phone:215-923-4322
Mailing Address - Fax:215-928-1274
Practice Address - Street 1:604 S 10TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1918
Practice Address - Country:US
Practice Address - Phone:215-923-4322
Practice Address - Fax:215-928-1274
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003693L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist