Provider Demographics
NPI:1235464140
Name:TAYLOR, BONNIE PAIGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:PAIGE
Last Name:TAYLOR
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 1:445 E 80TH ST
Mailing Address - Street 2:3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0616
Mailing Address - Country:US
Mailing Address - Phone:646-660-4562
Mailing Address - Fax:
Practice Address - Street 1:445 E 80TH ST
Practice Address - Street 2:3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0616
Practice Address - Country:US
Practice Address - Phone:646-660-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017954103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist