Provider Demographics
NPI:1881629913
Name:BONNER, BERNARD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:BONNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 CHESTNUT STREET SUITE 607
Mailing Address - Street 2:DR ROBIN LOWEY & ASSOCIATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-625-9655
Mailing Address - Fax:215-625-8524
Practice Address - Street 1:1920 COTTMAN AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-625-9655
Practice Address - Fax:215-625-8524
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007488L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA27063900OtherMAGELLAN
PAB0793861OtherHIGHMARK BLUE SHIELD
PA793861Medicare ID - Type Unspecified