Healthcare Provider Details

I. General information

NPI: 1790221562
Provider Name (Legal Business Name): BONNIE RICARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 OLD FREEPORT RD 1AF
PITTSBURGH PA
15238-3115
US

IV. Provider business mailing address

170 JAMISON LN SUITE 1
MONROEVILLE PA
15146-2327
US

V. Phone/Fax

Practice location:
  • Phone: 412-406-7052
  • Fax: 412-406-7139
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC002539
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: