Provider Demographics
NPI:1720145428
Name:POPSO, BONNIE L
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:POPSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:POPSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:MT MORRIS
Mailing Address - State:PA
Mailing Address - Zip Code:15349-0495
Mailing Address - Country:US
Mailing Address - Phone:724-324-9001
Mailing Address - Fax:724-324-9005
Practice Address - Street 1:105 FRONT STREET
Practice Address - Street 2:
Practice Address - City:MT MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349
Practice Address - Country:US
Practice Address - Phone:724-324-9001
Practice Address - Fax:724-324-9005
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA540369OtherVALUE BEHAVIORAL HEALTH
PA101745151 0001Medicaid
PA101745151 0001Medicaid