Provider Demographics
NPI:1508302548
Name:NEZAJ, VALBONA BONNIE
Entity Type:Individual
Prefix:
First Name:VALBONA
Middle Name:BONNIE
Last Name:NEZAJ
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 1:17 E 7TH ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-8091
Mailing Address - Country:US
Mailing Address - Phone:917-648-9733
Mailing Address - Fax:
Practice Address - Street 1:99 UNIVERSITY PL STE 205
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4575
Practice Address - Country:US
Practice Address - Phone:917-648-9733
Practice Address - Fax:917-648-9733
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000986102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst