Provider Demographics
NPI:1043075674
Name:BONOMI, DARBY FURTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARBY
Middle Name:FURTH
Last Name:BONOMI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ALTA WAY
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1557
Mailing Address - Country:US
Mailing Address - Phone:415-713-4234
Mailing Address - Fax:
Practice Address - Street 1:8 ALTA WAY
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1557
Practice Address - Country:US
Practice Address - Phone:415-713-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12925103TC0700X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical