Provider Demographics
NPI:1265843742
Name:BROWN-BONANNO, ELIZABETH ILA (BA PSY)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ILA
Last Name:BROWN-BONANNO
Suffix:
Gender:F
Credentials:BA PSY
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:291 MERRYMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4850
Mailing Address - Country:US
Mailing Address - Phone:917-795-6293
Mailing Address - Fax:
Practice Address - Street 1:291 MERRYMOUNT ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4850
Practice Address - Country:US
Practice Address - Phone:917-795-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst