Provider Demographics
NPI:1558664367
Name:BONNER, JULIUS JOHN (PC)
Entity type:Individual
Prefix:
First Name:JULIUS
Middle Name:JOHN
Last Name:BONNER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 FABIEN ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6277
Mailing Address - Country:US
Mailing Address - Phone:401-765-3700
Mailing Address - Fax:401-769-6046
Practice Address - Street 1:80 FABIEN ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-6277
Practice Address - Country:US
Practice Address - Phone:401-765-3700
Practice Address - Fax:401-769-6046
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI501OtherPRINCIPAL COUNSELOR