Provider Demographics
NPI:1144458837
Name:GEARY, BONNIE (MFT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:GEARY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11260 WILBUR AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2450
Mailing Address - Country:US
Mailing Address - Phone:818-366-1860
Mailing Address - Fax:818-368-5391
Practice Address - Street 1:11260 WILBUR AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-2450
Practice Address - Country:US
Practice Address - Phone:818-366-1860
Practice Address - Fax:818-368-5391
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 26063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist