Provider Demographics
NPI:1053507608
Name:STETSON, BONNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:STETSON
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 1:9434 RIO GRANDE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1813
Mailing Address - Country:US
Mailing Address - Phone:505-899-9088
Mailing Address - Fax:505-898-0250
Practice Address - Street 1:9434 RIO GRANDE BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1813
Practice Address - Country:US
Practice Address - Phone:505-899-9088
Practice Address - Fax:505-898-0250
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM264138103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool