Provider Demographics
NPI:1366190977
Name:BESSELMAN, BONNIE ANN (MA, LBS)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ANN
Last Name:BESSELMAN
Suffix:
Gender:F
Credentials:MA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 LIMERICK RD
Mailing Address - Street 2:
Mailing Address - City:HERMINIE
Mailing Address - State:PA
Mailing Address - Zip Code:15637-1531
Mailing Address - Country:US
Mailing Address - Phone:724-396-6680
Mailing Address - Fax:
Practice Address - Street 1:178 LIMERICK RD
Practice Address - Street 2:
Practice Address - City:HERMINIE
Practice Address - State:PA
Practice Address - Zip Code:15637-1531
Practice Address - Country:US
Practice Address - Phone:724-396-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15637Medicaid
PA15637OtherBEHAVIOR CONSULTANT