Provider Demographics
NPI:1356555874
Name:BONIN, RENEE BABIN (PHD, MPAP)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:BABIN
Last Name:BONIN
Suffix:
Gender:F
Credentials:PHD, MPAP
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Other - First Name:
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Mailing Address - Street 1:601 W SAINT MARY BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3568
Mailing Address - Country:US
Mailing Address - Phone:337-233-7867
Mailing Address - Fax:337-235-7199
Practice Address - Street 1:200 BEAULLIEU DR BLDG 9B-1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7230
Practice Address - Country:US
Practice Address - Phone:337-504-3483
Practice Address - Fax:337-504-3573
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMP.0005103T00000X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist