Active NPI
Bridgette Lee Bonifas
- Professional Counselor
- Fairborn, OH
National Provider Identifier
1922584176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.2303747
- Practice address
- 1016 Rainbow CT
Fairborn, OH 45324-6365 - Phone
- (937) 641-3401
- Fax
- (937) 641-3046
- NPI assigned
- Jul 11, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E.2303747 | OH | Primary |
Addresses
Primary practice location
1016 Rainbow CT
Fairborn, OH 45324-6365
Mailing address
PO Box 933421
Cleveland, OH 44193-0039
Phone (937) 641-4000
Other practice location 1
410 Valley St
Dayton, OH 45404-1843
Phone (937) 641-3401
Other practice location 2
320 E Silver St
Lebanon, OH 45036-1887
Phone (937) 641-3401
Other names 1
- Bridgette L Bonifas-Smith
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.2303747 | OH | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Necco, LLC | Professional | Past | Accepting new patients |
| Necco, LLC | Professional | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696636800000",
"number": "1922584176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 933421",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441930039",
"telephone_number": "937-641-4000",
"fax_number": "937-641-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1016 RAINBOW CT",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453246365",
"telephone_number": "937-641-3401",
"fax_number": "937-641-3046"
}
],
"practiceLocations": [
{
"address_1": "410 Valley St",
"address_purpose": "LOCATION",
"city": "Dayton",
"state": "OH",
"postal_code": "454041843",
"country_code": "US",
"telephone_number": "937-641-3401",
"fax_number": "937-641-3046",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "320 E Silver St",
"address_purpose": "LOCATION",
"city": "Lebanon",
"state": "OH",
"postal_code": "450361887",
"country_code": "US",
"telephone_number": "937-641-3401",
"fax_number": "937-641-3046",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BONIFAS",
"first_name": "BRIDGETTE",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-11",
"last_updated": "2023-10-07",
"certification_date": "2023-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.2303747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRIDGETTE",
"last_name": "BONIFAS-SMITH",
"middle_name": "L",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.