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General NPI Number Information
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NPI Number | 1831109503
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Entity Type | Organization
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Legal Business Name | DR MARCELA A BONAFINA-CARACCIOLI PSYCHOLOGIST PC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 2109 BROADWAY SUITE 520
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City | NEW YORK
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State | NY
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Zip | 10023
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Country | US
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Telephone | 212-579-7272
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Fax | 212-579-2851
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Provider Business Mailing Address
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Address Line | 2109 BROADWAY SUITE 520
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City | NEW YORK
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State | NY
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Zip | 10023
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Country | US
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Telephone | 212-579-7272
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Fax | 212-579-2851
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Authorized Official
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Title or Position | PRESIDENT OF PC
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Name | DR. MARCELA ANDREA BONAFINA-CARACCIOLI
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Credential | PHD
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Telephone | 212-579-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P160781
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 0160781
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License Number State | NY
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