Provider Demographics
NPI:1013341395
Name:BONEY, JACOB (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:BONEY
Suffix:
Gender:M
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 S 55TH ST
Mailing Address - Street 2:APT 3011
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2039
Mailing Address - Country:US
Mailing Address - Phone:602-926-7200
Mailing Address - Fax:
Practice Address - Street 1:10251 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1305
Practice Address - Country:US
Practice Address - Phone:602-926-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-91103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst