Provider Demographics
NPI:1083246144
Name:BONACI, BRIGITTE (CB)
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
Last Name:BONACI
Suffix:
Gender:F
Credentials:CB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3276 CALIFORNIA AVE SW # A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3305
Mailing Address - Country:US
Mailing Address - Phone:425-691-6847
Mailing Address - Fax:208-416-6922
Practice Address - Street 1:1814 216TH PL NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-4115
Practice Address - Country:US
Practice Address - Phone:425-588-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61041162106S00000X
WABA61482376103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACB61041162OtherWASHINGTON STATE DEPARTMENT OF HEALTH