Provider Demographics
NPI:1174782379
Name:BONAFINA, MARCELA A (PHD)
Entity type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:A
Last Name:BONAFINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARCELA
Other - Middle Name:A
Other - Last Name:BONAFINA-CARACCIOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 W IH 10 STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4776
Mailing Address - Country:US
Mailing Address - Phone:210-428-5814
Mailing Address - Fax:210-536-6385
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-539-9582
Practice Address - Fax:210-536-6385
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0160781103G00000X, 103TC0700X, 103T00000X
CAPSY21985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ32027Medicare UPIN