Provider Demographics
NPI:1174567291
Name:BONTEMPO, JOHN (LISW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BONTEMPO
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1716
Mailing Address - Country:US
Mailing Address - Phone:440-234-1900
Mailing Address - Fax:440-234-2072
Practice Address - Street 1:429 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1716
Practice Address - Country:US
Practice Address - Phone:440-234-1900
Practice Address - Fax:440-234-2072
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-71131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical