Provider Demographics
NPI:1922733195
Name:DEKIN, BONNIE (LMFT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:DEKIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 W DOMINICK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3973
Mailing Address - Country:US
Mailing Address - Phone:315-334-2166
Mailing Address - Fax:
Practice Address - Street 1:3070 BELGIUM RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9546
Practice Address - Country:US
Practice Address - Phone:315-720-1118
Practice Address - Fax:315-720-1171
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist