Provider Demographics
NPI:1124517883
Name:BONET BELTRAN, YAJAHIRA (LSW)
Entity type:Individual
Prefix:
First Name:YAJAHIRA
Middle Name:
Last Name:BONET BELTRAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GINESI DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1249
Mailing Address - Country:US
Mailing Address - Phone:732-380-7449
Mailing Address - Fax:
Practice Address - Street 1:704 GINESI DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1249
Practice Address - Country:US
Practice Address - Phone:732-380-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06381200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty