Provider Demographics
NPI:1285440495
Name:CORONADO, BRIGITTE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:BRIGITTE
Other - Middle Name:
Other - Last Name:BONTEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1207 W STAR CT
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85144-1589
Mailing Address - Country:US
Mailing Address - Phone:602-810-2291
Mailing Address - Fax:
Practice Address - Street 1:6859 E REMBRANDT AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3629
Practice Address - Country:US
Practice Address - Phone:480-389-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-001568103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst