Provider Demographics
NPI:1104711001
Name:BONOMO, NICOLE RENEE (BCBA, LBA-NY)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:BONOMO
Suffix:
Gender:F
Credentials:BCBA, LBA-NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2020
Mailing Address - Country:US
Mailing Address - Phone:516-512-4513
Mailing Address - Fax:
Practice Address - Street 1:6 MARTHA RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1406
Practice Address - Country:US
Practice Address - Phone:845-327-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004321103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst