Provider Demographics
NPI:1831667690
Name:BONUSO, CARA FLAVIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:FLAVIA
Last Name:BONUSO
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 1:525 CONVENT RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3868
Mailing Address - Country:US
Mailing Address - Phone:516-921-0808
Mailing Address - Fax:
Practice Address - Street 1:525 CONVENT RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3868
Practice Address - Country:US
Practice Address - Phone:516-921-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021125103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent