Provider Demographics
NPI:1528320215
Name:BONNY, MADONNA (MSED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:
Last Name:BONNY
Suffix:
Gender:F
Credentials:MSED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 85TH ST
Mailing Address - Street 2:#4F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4717
Mailing Address - Country:US
Mailing Address - Phone:718-207-0959
Mailing Address - Fax:
Practice Address - Street 1:488 85TH ST
Practice Address - Street 2:#4F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4717
Practice Address - Country:US
Practice Address - Phone:718-207-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-09
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1849683174400000X
NY001205-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist