Provider Demographics
NPI:1518416411
Name:PLUTA, BONNIE LYNN (MS, BCBA, BSL)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:PLUTA
Suffix:
Gender:F
Credentials:MS, BCBA, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BUTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1506
Mailing Address - Country:US
Mailing Address - Phone:610-804-1444
Mailing Address - Fax:
Practice Address - Street 1:15 BUTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1506
Practice Address - Country:US
Practice Address - Phone:610-804-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003094103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst