Provider Demographics
NPI:1033706940
Name:BONAFE, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BONAFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BRICKELL AVE APT 2203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3937
Mailing Address - Country:US
Mailing Address - Phone:786-803-5964
Mailing Address - Fax:
Practice Address - Street 1:951 BRICKELL AVE APT 2203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3937
Practice Address - Country:US
Practice Address - Phone:786-803-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst