Healthcare Provider Details

I. General information

NPI: 1124950258
Provider Name (Legal Business Name): BONFIRE THERAPY LMHC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 BROADWAY # 2123
NEW YORK NY
10024-5805
US

IV. Provider business mailing address

2248 BROADWAY # 2123
NEW YORK NY
10024-5805
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-0223
  • Fax:
Mailing address:
  • Phone: 917-410-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN MATTHEW VARGAS
Title or Position: MEMBER-MANAGER
Credential: LMHC
Phone: 917-410-0223