1558663054 NPI number — MS. ALISHIA MARIE BONASERA M.S., BCBA

Table of content: MS. ALISHIA MARIE BONASERA M.S., BCBA (NPI 1558663054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558663054 NPI number — MS. ALISHIA MARIE BONASERA M.S., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONASERA
Provider First Name:
ALISHIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558663054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 SAINT JOHNS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCOA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-639-9800
Provider Business Mailing Address Fax Number:
321-639-6007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 SAINT JOHNS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCOA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-639-9800
Provider Business Practice Location Address Fax Number:
321-639-6007
Provider Enumeration Date:
12/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-10-7607 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com