Provider Demographics
NPI:1700843604
Name:DELONG, BONNIE JK (MA)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JK
Last Name:DELONG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CLOVER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-9130
Mailing Address - Country:US
Mailing Address - Phone:610-683-5061
Mailing Address - Fax:
Practice Address - Street 1:510 N PARK RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2941
Practice Address - Country:US
Practice Address - Phone:610-375-4080
Practice Address - Fax:610-375-7363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005933L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist