Provider Demographics
NPI:1689859803
Name:PISANO, BONNIE KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:KAY
Last Name:PISANO
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 1:10293 N MERIDIAN ST
Mailing Address - Street 2:SUITE 375
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1123
Mailing Address - Country:US
Mailing Address - Phone:317-581-2288
Mailing Address - Fax:317-581-2295
Practice Address - Street 1:10293 N MERIDIAN ST
Practice Address - Street 2:SUITE 375
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1123
Practice Address - Country:US
Practice Address - Phone:317-581-2288
Practice Address - Fax:317-581-2295
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN40020551A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling