Provider Demographics
NPI:1356363881
Name:BONEM, HOWARD MORRIS (PHD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MORRIS
Last Name:BONEM
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 1:20600 CHAGRIN BLVD
Mailing Address - Street 2:#750
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5327
Mailing Address - Country:US
Mailing Address - Phone:216-916-9276
Mailing Address - Fax:216-763-9700
Practice Address - Street 1:20600 CHAGRIN BLVD
Practice Address - Street 2:#750
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5327
Practice Address - Country:US
Practice Address - Phone:216-916-9276
Practice Address - Fax:216-763-9700
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical