Provider Demographics
NPI:1205530896
Name:BONILLA, JASMIN (MS, LMHC)
Entity type:Individual
Prefix:MRS
First Name:JASMIN
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:MS
Other - First Name:JASMIN
Other - Middle Name:
Other - Last Name:FELICIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3305 JERUSALEM AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2219
Mailing Address - Country:US
Mailing Address - Phone:347-376-2491
Mailing Address - Fax:
Practice Address - Street 1:3305 JERUSALEM AVE STE 207
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2219
Practice Address - Country:US
Practice Address - Phone:347-376-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013269-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health