MEDICARE: VICTORIA BONAR

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
1	101YM0800X	Mental Health Counselor	99126728A	IN
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1760216758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA BONAR

Provider Business Mailing Address
First Line	:	3159 CARPENTERS PARK RD
Second Line	:
City	:	DAVIDSVILLE
State	:	PA
Zip	:	15928-9223
Country	:	US
Telephone Number	:	814-408-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 CHARLESTOWN RD STE 300
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-2691
Country	:	US
Telephone Number	:	814-408-0014
Fax Number	:	814-479-5906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/30/2024

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Directions to “ VICTORIA BONAR ” Practice Location

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