Provider Demographics
NPI:1952404030
Name:GLADU, BONNIE SUE (LPCMH)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SUE
Last Name:GLADU
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 SLAUGHTER STATION RD
Mailing Address - Street 2:
Mailing Address - City:HARTLY
Mailing Address - State:DE
Mailing Address - Zip Code:19953-3208
Mailing Address - Country:US
Mailing Address - Phone:302-492-0161
Mailing Address - Fax:
Practice Address - Street 1:907 S GOVERNORS AVE STE 3
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4122
Practice Address - Country:US
Practice Address - Phone:302-674-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021587Medicaid