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NPI Code Detail

MEDICARE: MRS. JANE BONK-THOMSON L.C.S.W.

MEDICARE: MRS. JANE BONK-THOMSON L.C.S.W.
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
1101YM0800XMental Health CounselorSW2122FL

General Provider Information

NPI Number : 1922134006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JANE BONK-THOMSON L.C.S.W.
Provider Business Mailing Address
First Line : 700 UNIVERSE BLVD
Second Line : EAP/JB
City : JUNO BEACH
State : FL
Zip : 33408-2657
Country : US
Telephone Number : 561-236-1207
Fax Number : 561-691-7899
Provider Business Practice Location Address
First Line : 700 UNIVERSE BLVD
Second Line : EAP/JB
City : JUNO BEACH
State : FL
Zip : 33408-2657
Country : US
Telephone Number : 561-236-1207
Fax Number : 561-691-7899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 11/02/2011

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