Provider Demographics
NPI:1144624602
Name:BRONAUGH, LAMONICA
Entity type:Individual
Prefix:
First Name:LAMONICA
Middle Name:
Last Name:BRONAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LONGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8067
Mailing Address - Country:US
Mailing Address - Phone:567-277-3170
Mailing Address - Fax:
Practice Address - Street 1:211 LONGMEADOW DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8067
Practice Address - Country:US
Practice Address - Phone:567-277-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.14503541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical