MEDICARE: STEVEN BONCEK M.A., BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-13-12859	TX

General Provider Information

NPI Number	:	1851721849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN BONCEK M.A., BCBA

Provider Business Mailing Address
First Line	:	11106 CEDAR PARK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4291
Country	:	US
Telephone Number	:	210-838-4917
Fax Number	:

Provider Business Practice Location Address
First Line	:	11106 CEDAR PARK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4291
Country	:	US
Telephone Number	:	210-838-4917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/12/2013

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