Provider Demographics
NPI:1194947986
Name:BONE, JEFFREY KITTS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KITTS
Last Name:BONE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 CAMPUS DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2217
Mailing Address - Country:US
Mailing Address - Phone:949-375-4028
Mailing Address - Fax:949-861-6174
Practice Address - Street 1:4060 CAMPUS DR
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2217
Practice Address - Country:US
Practice Address - Phone:949-375-4028
Practice Address - Fax:949-861-6174
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical