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General NPI Number Information
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NPI Number | 1568372902
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Entity Type | Individual
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Provider Name | STEPHANIE NICOLE BONINFANTE
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Gender | Female
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 8869 N COUNTY ROAD 250 E
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City | ROACHDALE
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State | IN
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Zip | 46172-9496
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Country | US
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Telephone | 888-714-1927
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Fax |
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Provider Business Mailing Address
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Address Line | 4853 E MAIN ST
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City | AVON
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State | IN
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Zip | 46123-9176
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Country | US
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Telephone | 610-609-6172
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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 | 99138656A
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License Number State | IN
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