Provider Demographics
NPI:1538474895
Name:MASS, BONNIE LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYNN
Last Name:MASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1421
Mailing Address - Country:US
Mailing Address - Phone:310-395-5005
Mailing Address - Fax:
Practice Address - Street 1:530 WILSHIRE BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1421
Practice Address - Country:US
Practice Address - Phone:310-395-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical