Provider Demographics
NPI:1306854633
Name:KREBS, BONNIE (PH D)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:KREBS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880
Mailing Address - Country:US
Mailing Address - Phone:401-782-0046
Mailing Address - Fax:
Practice Address - Street 1:25 NORTH RD
Practice Address - Street 2:
Practice Address - City:PEACE DALE
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-782-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI417103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist