Provider Demographics
NPI:1063674273
Name:REICH, BONNIE G (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:G
Last Name:REICH
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 1:1280 S VICTORIA AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6555
Mailing Address - Country:US
Mailing Address - Phone:310-982-7505
Mailing Address - Fax:805-642-0996
Practice Address - Street 1:1280 S VICTORIA AVE
Practice Address - Street 2:STE 230
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6555
Practice Address - Country:US
Practice Address - Phone:310-982-7505
Practice Address - Fax:805-642-0996
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical