Individual
JANE M BONIFAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
13731 CONVERSE ROSELM RD, VENEDOCIA, OH 45894-9532
(419) 695-2194
Mailing address
13731 CONVERSE ROSELM RD, VENEDOCIA, OH 45894-9532
(419) 695-2194
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5315
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2054360
—
OH
01
—
680012644
ANTHEM RR
—
Enumeration date
12/06/2005
Last updated
01/03/2012
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