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General NPI Number Information
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NPI Number | 1245300110
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Entity Type | Individual
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Provider Name | DR. JENNIFER MARY BONOVITZ
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 191 PRESIDENTIAL BLVD SUITE 111A
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1207
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Country | US
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Telephone | 610-660-9760
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Fax |
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Provider Business Mailing Address
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Address Line | 214 DERWEN RD
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City | MERION STATION
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State | PA
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Zip | 19066-1207
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Country | US
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Telephone | 610-664-3785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW-000683-L
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License Number State | PA
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