Provider Demographics
NPI:1528624665
Name:BONURA, JOANNA ROSE (LMHC, CASAC-2)
Entity type:Individual
Prefix:MISS
First Name:JOANNA
Middle Name:ROSE
Last Name:BONURA
Suffix:
Gender:F
Credentials:LMHC, CASAC-2
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Mailing Address - Street 1:54 RIDGE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2136
Mailing Address - Country:US
Mailing Address - Phone:631-905-7391
Mailing Address - Fax:
Practice Address - Street 1:200 BELLE TERRE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1968
Practice Address - Country:US
Practice Address - Phone:631-474-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35008101YA0400X
NY015906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015906OtherTHE UNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT
NY35008OtherOASAS