Provider Demographics
NPI:1679086896
Name:SMITH-MAY, BONNIE JANET ELLEN (MA,ATR-BC,LCPAT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JANET ELLEN
Last Name:SMITH-MAY
Suffix:
Gender:F
Credentials:MA,ATR-BC,LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2130
Mailing Address - Country:US
Mailing Address - Phone:443-980-0049
Mailing Address - Fax:
Practice Address - Street 1:770 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2130
Practice Address - Country:US
Practice Address - Phone:443-980-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty