Provider Demographics
NPI:1811154446
Name:ENGEL, BONNIE ANDERSEN (PHD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:ANDERSEN
Last Name:ENGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W NEW YORK AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-943-9443
Mailing Address - Fax:386-943-9883
Practice Address - Street 1:1025 W NEW YORK AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-943-9443
Practice Address - Fax:386-943-9883
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2178103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist