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MR. DON BONHAM LMSW, CASAC

Addiction Substance Use Disorder

Fort Drum, New York

Provider NPI: 1326029489

Provider Information:
MR. DON  BONHAM LMSW, CASAC
Gender: M


Practice Location:
11050 MOUNT BELVEDERE BLVD USA MEDDAC - CREDENTIALS FORT DRUM, NY 13602 US
Tel: 315-772-4025  Fax: 315-772-9498

Business Mailing Address:
11050 MOUNT BELVEDERE BLVD USA MEDDAC - CREDENTIALS FORT DRUM, NY 13602 US
Tel: 315-772-4025  Fax: 315-772-9498

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
NY11769
X104100000XBehavioral Health & Social Service Providers
Social Worker
NY055937

Other Provider Identifiers:

IssuerNumberStateType
VAD00002
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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