Provider Demographics
NPI:1639506462
Name:WIMS, BONNIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:WIMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 EVANS ST
Mailing Address - Street 2:APT 2
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2148
Mailing Address - Country:US
Mailing Address - Phone:617-768-7101
Mailing Address - Fax:
Practice Address - Street 1:137 EVANS ST
Practice Address - Street 2:APT 2
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2148
Practice Address - Country:US
Practice Address - Phone:617-768-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health