Provider Demographics
NPI:1558878504
Name:BONDY, ALEXIS (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BONDY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3169
Mailing Address - Country:US
Mailing Address - Phone:856-625-8685
Mailing Address - Fax:
Practice Address - Street 1:230 BRAEN AVE STE D
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2948
Practice Address - Country:US
Practice Address - Phone:973-423-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-17-28112103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst