Elyssa Bonner
Psychologist, School in Fairfax, VA. Individual provider (NPI-1).
NPI number1629610092
StatusActive
Last updated in NPPESDec 16, 2025
Details
- NPI
- 1629610092
- Entity type
- Individual (NPI-1)
- Name
- Elyssa Bonner
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 17, 2019
- Certification date
- Dec 16, 2025
- Last updated
- Dec 16, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TS0200X | Psychologist, School | PPS-0607528 | VA | Yes |
| 171M00000X | Case Manager/Care Coordinator | PPS-0607528 | VA |
Practice location
8270 Willow Oaks Corporate DrFairfax, VA 22031-4530
Phone 571-423-4900
Mailing address
8270 Willow Oaks Corporate DrFairfax, VA 22031-4530
Phone 571-423-4900
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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