Provider Demographics
NPI:1609041094
Name:GOLDMAN, BONNIE L (LMHC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:L
Last Name:GOLDMAN
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 1:9033 GLADES RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3939
Mailing Address - Country:US
Mailing Address - Phone:561-361-0500
Mailing Address - Fax:561-479-0384
Practice Address - Street 1:9033 GLADES RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3939
Practice Address - Country:US
Practice Address - Phone:561-361-0500
Practice Address - Fax:561-479-0384
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health