Jaclyn Marie Bonventre

Primary specialty

SpecialistTaxonomy code 174400000X

License

484461041 Issued in NY

Practice address

18 Cynthia LN
Center Moriches, NY 11934-2602

Phone

(631) 909-2065

NPI assigned

Apr 20, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1114361219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 CYNTHIA LN",
            "city": "CENTER MORICHES",
            "state": "NY",
            "postal_code": "119342602",
            "telephone_number": "631-909-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 CYNTHIA LN",
            "city": "CENTER MORICHES",
            "state": "NY",
            "postal_code": "119342602",
            "telephone_number": "631-909-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONVENTRE",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-20",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "484461041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha Christine Baker, D.M.D.
• Melanie Bamberger, COTA/L
• Kristen Beardsley
• Dana Berge, LMSW
• Pramod Bhanti, PT
• Amanda Loree Bowcock, LMHC
• Patricia M Brandt
• Breakthrough Living Mental Health Counseling PLLC
• Jon Brennan, R-LCSW
• Emily Ann Brophy

• Specialist in Center Moriches, NY
• Providers in Center Moriches, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.