Provider Demographics
NPI:1861962268
Name:NABONG, KEVIN JOSEPH MARIANO I
Entity type:Individual
Prefix:MR
First Name:KEVIN JOSEPH
Middle Name:MARIANO
Last Name:NABONG
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15721 N GREENWY HDN LOOP STE 103
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1776
Mailing Address - Country:US
Mailing Address - Phone:602-362-4200
Mailing Address - Fax:
Practice Address - Street 1:15721 N GREENWY HDN LOOP STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1776
Practice Address - Country:US
Practice Address - Phone:602-362-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07319753103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst