Provider Demographics
NPI:1447362546
Name:BONGIOVANNI, CLAIRE AMBER (MA)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:AMBER
Last Name:BONGIOVANNI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CLAIRE
Other - Middle Name:AMBER
Other - Last Name:SOITHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2245 W BROADWAY APT N207
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1320
Mailing Address - Country:US
Mailing Address - Phone:310-309-9022
Mailing Address - Fax:
Practice Address - Street 1:111 N LA BREA AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1752
Practice Address - Country:US
Practice Address - Phone:310-855-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist