Healthcare Provider Details

I. General information

NPI: 1982703088
Provider Name (Legal Business Name): STEPHEN F. BONO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR PAIN MANAGEMENT CENTER
BALTIMORE MD
21207-6665
US

IV. Provider business mailing address

126 W LEE ST
BALTIMORE MD
21201-2421
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-6624
  • Fax: 410-448-6825
Mailing address:
  • Phone: 410-547-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: