Provider Demographics
NPI:1730605981
Name:KOBLENZ, BONNIE JANE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JANE
Last Name:KOBLENZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2303
Mailing Address - Country:US
Mailing Address - Phone:516-822-3131
Mailing Address - Fax:
Practice Address - Street 1:12 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3802
Practice Address - Country:US
Practice Address - Phone:516-822-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP04420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health