Provider Demographics
NPI:1831109503
Name:DR MARCELA A BONAFINA-CARACCIOLI PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:DR MARCELA A BONAFINA-CARACCIOLI PSYCHOLOGIST PC
Other - Org Name:MARCELA A BONAFINA-CARACCIOLI PHD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:BONAFINA-CARACCIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-579-7272
Mailing Address - Street 1:2109 BROADWAY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-579-7272
Mailing Address - Fax:212-579-2851
Practice Address - Street 1:2109 BROADWAY
Practice Address - Street 2:SUITE 520
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-579-7272
Practice Address - Fax:212-579-2851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0160781103G00000X
NYP160781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM6491Medicare ID - Type Unspecified
Q32027Medicare UPIN