Provider Demographics
NPI:1588912604
Name:BONTA, JEREMY (LMHC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BONTA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 N MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5498
Mailing Address - Country:US
Mailing Address - Phone:561-622-5423
Mailing Address - Fax:772-546-8434
Practice Address - Street 1:9625 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5498
Practice Address - Country:US
Practice Address - Phone:561-622-5423
Practice Address - Fax:772-546-8434
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor