Healthcare Provider Details

I. General information

NPI: 1649301516
Provider Name (Legal Business Name): BONNIE A MARRON M.ED, LPPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E BAGLEY RD
BEREA OH
44017-2058
US

IV. Provider business mailing address

202 E BAGLEY RD
BEREA OH
44017-2058
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-8228
  • Fax: 440-234-0787
Mailing address:
  • Phone: 440-260-8228
  • Fax: 440-234-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0003732 SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: