Provider Demographics
NPI:1598305542
Name:BONENFANT, KAYLI MARIE (MED)
Entity type:Individual
Prefix:
First Name:KAYLI
Middle Name:MARIE
Last Name:BONENFANT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 63RD DR APT 5D
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2301
Mailing Address - Country:US
Mailing Address - Phone:774-503-9488
Mailing Address - Fax:
Practice Address - Street 1:9822 63RD DR APT 5D
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2301
Practice Address - Country:US
Practice Address - Phone:774-503-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002618103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst