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General NPI Number Information
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NPI Number | 1619308731
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Entity Type | Individual
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Provider Name | CAROLINE MARIE BONFANTI PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2013
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 24 WINNIPEG LN
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City | LAWRENCE
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State | NJ
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Zip | 08648-4119
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Country | US
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Telephone | 609-334-8096
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 SCHRADER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90028-6213
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Country | US
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Telephone | 323-993-7400
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | F401818-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00456300
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License Number State | NJ
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