Individual
BONNIE NEIDECKER SOUKUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, NCC
Contact information
Practice address
435 MAIN ST STE 5, ISLIP, NY 11751-3536
(631) 664-1582
Mailing address
30 13TH ST, BOHEMIA, NY 11716-4420
(636) 697-8400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
004684
NY
Other
Enumeration date
10/14/2018
Last updated
10/14/2018
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