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General NPI Number Information
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NPI Number | 1700843604
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Entity Type | Individual
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Provider Name | BONNIE J.K. DELONG M.A.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 510 N PARK RD
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City | WYOMISSING
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State | PA
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Zip | 19610-2941
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Country | US
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Telephone | 610-375-4080
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Fax | 610-375-7363
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Provider Business Mailing Address
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Address Line | 235 CLOVER VALLEY RD
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City | KUTZTOWN
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State | PA
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Zip | 19530-9130
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Country | US
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Telephone | 610-683-5061
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS005933L
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License Number State | PA
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