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General NPI Number Information
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NPI Number | 1902762701
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Entity Type | Individual
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Provider Name | LISA MARIE BONOCORE LAPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 12/24/2025
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 41 N SCOTT ST
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City | CARBONDALE
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State | PA
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Zip | 18407-1814
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Country | US
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Telephone | 570-230-7614
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Fax |
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Provider Business Mailing Address
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Address Line | 110 TUCKERMANS RAVINE
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City | TAFTON
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State | PA
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Zip | 18464-9650
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Country | US
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Telephone | 570-290-3575
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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 | APC002007
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License Number State | PA
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