Provider Demographics
NPI:1912515396
Name:BONENFANT, JASMINE
Entity Type:Individual
Prefix:MISS
First Name:JASMINE
Middle Name:
Last Name:BONENFANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9170 CROWNE SPRINGS VW APT 215
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-1278
Mailing Address - Country:US
Mailing Address - Phone:774-254-7189
Mailing Address - Fax:
Practice Address - Street 1:5 KENNEY LN
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-4148
Practice Address - Country:US
Practice Address - Phone:774-254-7189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2024-04-15
Deactivation Date:2024-03-12
Deactivation Code:
Reactivation Date:2024-04-13
Provider Licenses
StateLicense IDTaxonomies
CO0021835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health