Healthcare Provider Details

I. General information

NPI: 1598305542
Provider Name (Legal Business Name): KAYLI MARIE BONENFANT M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLI HAMBLIN

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLL GATE RD STE 309
WARWICK RI
02886-4463
US

IV. Provider business mailing address

33 CRESCENT AVE
RIVERSIDE RI
02915-5411
US

V. Phone/Fax

Practice location:
  • Phone: 774-503-9488
  • Fax:
Mailing address:
  • Phone: 774-503-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA3395
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00475
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002618
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: