Healthcare Provider Details

I. General information

NPI: 1831109503
Provider Name (Legal Business Name): DR MARCELA A BONAFINA-CARACCIOLI PSYCHOLOGIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 BROADWAY SUITE 520
NEW YORK NY
10023
US

IV. Provider business mailing address

2109 BROADWAY SUITE 520
NEW YORK NY
10023
US

V. Phone/Fax

Practice location:
  • Phone: 212-579-7272
  • Fax: 212-579-2851
Mailing address:
  • Phone: 212-579-7272
  • Fax: 212-579-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0160781
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP160781
License Number StateNY

VIII. Authorized Official

Name: DR. MARCELA ANDREA BONAFINA-CARACCIOLI
Title or Position: PRESIDENT OF PC
Credential: PHD
Phone: 212-579-7272