Provider Demographics
NPI:1396137048
Name:BONNER, ELFRIDA (PHD)
Entity type:Individual
Prefix:DR
First Name:ELFRIDA
Middle Name:
Last Name:BONNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 PINELAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3902
Mailing Address - Country:US
Mailing Address - Phone:516-536-7603
Mailing Address - Fax:
Practice Address - Street 1:914 PINELAKE DR
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3902
Practice Address - Country:US
Practice Address - Phone:516-536-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021057-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical