Provider Demographics
NPI:1841767605
Name:BIBEL, BONNY L (BCBA)
Entity Type:Individual
Prefix:MS
First Name:BONNY
Middle Name:L
Last Name:BIBEL
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 1:288 MARJORIE BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4627
Mailing Address - Country:US
Mailing Address - Phone:312-351-1803
Mailing Address - Fax:
Practice Address - Street 1:288 MARJORIE BLVD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4627
Practice Address - Country:US
Practice Address - Phone:312-351-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-18-29146103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst