Provider Demographics
NPI:1619002094
Name:BONAPACE, ARLENE (PSYD)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:BONAPACE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 EASTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1856
Mailing Address - Country:US
Mailing Address - Phone:732-418-1122
Mailing Address - Fax:732-937-8081
Practice Address - Street 1:764 EASTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1856
Practice Address - Country:US
Practice Address - Phone:732-418-1122
Practice Address - Fax:732-937-8081
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00312000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1205033560OtherGROUP NPI NUMBER
NJ406667Medicare ID - Type Unspecified