Provider Demographics
NPI:1871858696
Name:LONG BONELLI, EILEEN (MS SP ED)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:LONG BONELLI
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DELAFIELD ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1749
Mailing Address - Country:US
Mailing Address - Phone:845-462-0079
Mailing Address - Fax:
Practice Address - Street 1:115 DELAFIELD ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1749
Practice Address - Country:US
Practice Address - Phone:845-462-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186368081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist