MEDICARE: SHARON KIMBERLAE BONCEK LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	001114-1	NY

General Provider Information

NPI Number	:	1467661835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON KIMBERLAE BONCEK LMHC

Provider Business Mailing Address
First Line	:	5 W CAYUGA ST
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-2031
Country	:	US
Telephone Number	:	315-342-1493
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 WEST CAYUGA STREET
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-3132
Country	:	US
Telephone Number	:	315-342-1493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/28/2024

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