Provider Demographics
NPI:1912059585
Name:BONNER, KIMBERLY LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:BONNER
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 1:961 MARCON BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109
Mailing Address - Country:US
Mailing Address - Phone:610-266-0610
Mailing Address - Fax:610-266-0292
Practice Address - Street 1:961 MARCON BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109
Practice Address - Country:US
Practice Address - Phone:610-266-0610
Practice Address - Fax:610-266-0292
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
50031896OtherCAPITAL BC