Provider Demographics
NPI:1487873451
Name:THOMAS O. BONNER, PH.D., P.A.
Entity type:Organization
Organization Name:THOMAS O. BONNER, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-595-1616
Mailing Address - Street 1:9480 SW 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7903
Mailing Address - Country:US
Mailing Address - Phone:305-595-1616
Mailing Address - Fax:305-595-7272
Practice Address - Street 1:9480 SW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7903
Practice Address - Country:US
Practice Address - Phone:305-595-1616
Practice Address - Fax:305-595-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty