Provider Demographics
NPI:1588242796
Name:BONUS, PAUL JAY
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JAY
Last Name:BONUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CAIRNBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:15924-9701
Mailing Address - Country:US
Mailing Address - Phone:814-279-8426
Mailing Address - Fax:
Practice Address - Street 1:245 W RACE ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1922
Practice Address - Country:US
Practice Address - Phone:814-443-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health