Healthcare Provider Details

I. General information

NPI: 1801946207
Provider Name (Legal Business Name): BONNIE R. CORMAN PHD, MFC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 DEPOT RD
SANTA BARBARA CA
93108-2808
US

IV. Provider business mailing address

91 DEPOT RD
SANTA BARBARA CA
93108-2808
US

V. Phone/Fax

Practice location:
  • Phone: 805-969-3959
  • Fax:
Mailing address:
  • Phone: 805-969-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberMFC22577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: