Provider Demographics
NPI:1841873650
Name:BONO, AMANDA DANIELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DANIELLE
Last Name:BONO
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 1:7500 N DREAMY DRAW DR STE 120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4641
Mailing Address - Country:US
Mailing Address - Phone:602-870-7470
Mailing Address - Fax:
Practice Address - Street 1:7500 N DREAMY DRAW DR STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4641
Practice Address - Country:US
Practice Address - Phone:602-870-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005317103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical