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General NPI Number Information
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NPI Number | 1497338339
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Entity Type | Individual
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Provider Name | MICHELLE BONILLA LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 401 BLOOMINGDALE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2010
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Country | US
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Telephone | 718-300-5655
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Fax |
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Provider Business Mailing Address
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Address Line | 308 N FELTUS ST
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City | SOUTH AMBOY
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State | NJ
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Zip | 08879-1245
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Country | US
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Telephone | 908-342-6255
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 011255
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License Number State | NY
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