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NPI Code Detail

MEDICARE: LAUREN LIBERTY BONICA MHC-LP

MEDICARE: LAUREN LIBERTY BONICA MHC-LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1356214225
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN LIBERTY BONICA MHC-LP
Provider Business Mailing Address
First Line : 65 PACIFIC ST
Second Line :
City : MASSAPEQUA PARK
State : NY
Zip : 11762-2840
Country : US
Telephone Number : 917-673-5850
Fax Number :
Provider Business Practice Location Address
First Line : 64 BROADWAY
Second Line :
City : AMITYVILLE
State : NY
Zip : 11701-2702
Country : US
Telephone Number : 631-296-1113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2025
Last Update Date : 05/04/2026

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