Provider Demographics
NPI:1780721324
Name:MARKHAM, BONNIE (PHD, PSYD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1831
Mailing Address - Country:US
Mailing Address - Phone:732-494-5471
Mailing Address - Fax:
Practice Address - Street 1:52 PEARL ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1831
Practice Address - Country:US
Practice Address - Phone:732-494-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00188500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA426846Medicare ID - Type Unspecified