Provider Demographics
NPI:1083125504
Name:WOODS, BONNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:WOODS
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:PO BOX 361212
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1212
Mailing Address - Country:US
Mailing Address - Phone:321-209-3115
Mailing Address - Fax:
Practice Address - Street 1:1413 S PATRICK DR STE 1
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4344
Practice Address - Country:US
Practice Address - Phone:321-209-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-10132103K00000X
FLPY9874103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst