Provider Demographics
NPI:1306962303
Name:BONN, ELENA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:M
Last Name:BONN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 TOWNSGATE ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2405
Mailing Address - Country:US
Mailing Address - Phone:805-379-1330
Mailing Address - Fax:
Practice Address - Street 1:2239 TOWNSGATE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2405
Practice Address - Country:US
Practice Address - Phone:805-379-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist