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General NPI Number Information
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NPI Number | 1376008524
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Entity Type | Individual
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Provider Name | BONNIE CHRISTINE MORAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 10 TINDALL RD STE 4
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2743
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Country | US
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Telephone | 732-580-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 253 MAIN ST STE 101
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City | MATAWAN
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State | NJ
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Zip | 07747-3222
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Country | US
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Telephone | 732-580-3728
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL05185900
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License Number State | NJ
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