Provider Demographics
NPI:1063139368
Name:BONAVENTURA, CHRISTINE M (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:BONAVENTURA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 LONGHURST RD
Mailing Address - Street 2:
Mailing Address - City:EVESHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1989
Mailing Address - Country:US
Mailing Address - Phone:609-923-6328
Mailing Address - Fax:
Practice Address - Street 1:54 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2002
Practice Address - Country:US
Practice Address - Phone:609-923-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional