Provider Demographics
NPI:1750133625
Name:BONINO, ALEXANDER (BCBA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BONINO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 PROVIDENCE HWY # 1188
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5001
Mailing Address - Country:US
Mailing Address - Phone:833-624-6385
Mailing Address - Fax:
Practice Address - Street 1:991 PROVIDENCE HWY # 1188
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5001
Practice Address - Country:US
Practice Address - Phone:833-624-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA571672103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst