Provider Demographics
NPI:1326186917
Name:BONVIE, MARIE-VERONIQUE JEANNE YVETTE
Entity Type:Individual
Prefix:MS
First Name:MARIE-VERONIQUE
Middle Name:JEANNE YVETTE
Last Name:BONVIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 SEAN LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3322
Mailing Address - Country:US
Mailing Address - Phone:239-543-6338
Mailing Address - Fax:
Practice Address - Street 1:7309 SEAN LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3322
Practice Address - Country:US
Practice Address - Phone:239-543-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL916691103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist