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General NPI Number Information
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NPI Number | 1528624665
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Entity Type | Individual
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Provider Name | JOANNA ROSE BONURA LMHC, CASAC-2
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Gender | Female
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 200 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1968
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Country | US
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Telephone | 631-474-6981
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Fax |
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Provider Business Mailing Address
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Address Line | 54 RIDGE HAVEN DR
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City | RIDGE
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State | NY
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Zip | 11961-2136
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Country | US
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Telephone | 631-905-7391
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 35008
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 015906
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License Number State | NY
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