Provider Demographics
NPI:1558685263
Name:BONIN, LILLIAN JOAN (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:JOAN
Last Name:BONIN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BLUE HERON DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571-6035
Mailing Address - Country:US
Mailing Address - Phone:508-498-9907
Mailing Address - Fax:
Practice Address - Street 1:14 BLUE HERRON RD
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:MA
Practice Address - Zip Code:01571-6035
Practice Address - Country:US
Practice Address - Phone:508-498-9907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA000009411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health