Basic Information
| Provider Information | |||||||||
| NPI: | 1396033023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAFONTE | ||||||||
| FirstName: | BONNIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 594 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330717615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543446550 | ||||||||
| FaxNumber: | 9543448634 | ||||||||
| Practice Location | |||||||||
| Address1: | 594 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330717615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543446550 | ||||||||
| FaxNumber: | 9543448634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2011 | ||||||||
| LastUpdateDate: | 11/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 222Q00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.