Provider Demographics
NPI:1114171055
Name:BONET, ELIZABETH GORHAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GORHAM
Last Name:BONET
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 1:3325 HOLLYWOOD BLVD
Mailing Address - Street 2:STE. 401
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6999
Mailing Address - Country:US
Mailing Address - Phone:954-309-9071
Mailing Address - Fax:267-647-2888
Practice Address - Street 1:3325 HOLLYWOOD BLVD
Practice Address - Street 2:STE. 401
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6999
Practice Address - Country:US
Practice Address - Phone:954-309-9071
Practice Address - Fax:267-647-2888
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health