Provider Demographics
NPI:1376008524
Name:MORAN, BONNIE CHRISTINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:CHRISTINE
Last Name:MORAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3222
Mailing Address - Country:US
Mailing Address - Phone:732-580-3728
Mailing Address - Fax:
Practice Address - Street 1:10 TINDALL RD STE 4
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2743
Practice Address - Country:US
Practice Address - Phone:732-580-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05185900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker