Provider Demographics
NPI:1891983136
Name:BOHNER, MARK NADEAU (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:NADEAU
Last Name:BOHNER
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 1:607 ELMIRA RD # 321
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4655
Mailing Address - Country:US
Mailing Address - Phone:707-246-3585
Mailing Address - Fax:
Practice Address - Street 1:595 BUCK AVE STE G
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3642
Practice Address - Country:US
Practice Address - Phone:707-246-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical