Provider Demographics
NPI:1497932495
Name:CARTER, BONNIE FRANK (PHD)
Entity Type:Individual
Prefix:
First Name:BONNIE FRANK
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 RADNOR RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2701
Mailing Address - Country:US
Mailing Address - Phone:610-688-9060
Mailing Address - Fax:610-688-9061
Practice Address - Street 1:939 RADNOR RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2701
Practice Address - Country:US
Practice Address - Phone:610-688-9060
Practice Address - Fax:610-688-9061
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003878L103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019604320001Medicaid
PA121316Medicare PIN