Provider Demographics
NPI:1720279623
Name:BONDY, STEPHEN BERT (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BERT
Last Name:BONDY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6729 FAIRVIEW RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0127
Mailing Address - Country:US
Mailing Address - Phone:704-442-9111
Mailing Address - Fax:704-442-0021
Practice Address - Street 1:6729-D FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3358
Practice Address - Country:US
Practice Address - Phone:704-442-9111
Practice Address - Fax:704-442-0021
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0271103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03142OtherBCBSNC
NC0271OtherLICENSE #
NC2814533CMedicare PIN