Provider Demographics
NPI:1851478903
Name:BONOMO, LAURA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:BONOMO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:647 FRANKLIN AVE STE LL4
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5746
Mailing Address - Country:US
Mailing Address - Phone:516-798-4070
Mailing Address - Fax:516-798-4070
Practice Address - Street 1:647 FRANKLIN AVE STE LL4
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5746
Practice Address - Country:US
Practice Address - Phone:516-798-4070
Practice Address - Fax:516-798-4070
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical