Basic Information
| Provider Information | |||||||||
| NPI: | 1770632549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARINE | ||||||||
| FirstName: | BONITA | ||||||||
| MiddleName: | EMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARINE | ||||||||
| OtherFirstName: | BONITA | ||||||||
| OtherMiddleName: | SUSAN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PH.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | JAMES A. HALEY VETERANS' HOSPITAL | ||||||||
| Address2: | 13000 BRUCE B. DOWNS BLVD. | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139722000 | ||||||||
| FaxNumber: | 8139727673 | ||||||||
| Practice Location | |||||||||
| Address1: | JAMES A. HALEY VETERANS' HOSPITAL | ||||||||
| Address2: | 13000 BRUCE B. DOWNS BLVD. | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139722000 | ||||||||
| FaxNumber: | 8139727673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 02/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY6154 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.