Provider Demographics
NPI:1083152417
Name:BONOMO, ANNETTE (MS,ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:BONOMO
Suffix:
Gender:F
Credentials:MS,ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ELIZABETH ST
Mailing Address - Street 2:PARENT CHILD RESOURCE CENTER
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418
Mailing Address - Country:US
Mailing Address - Phone:203-954-0543
Mailing Address - Fax:
Practice Address - Street 1:30 ELIZABETH ST
Practice Address - Street 2:PARENT CHILD RESOURCE CENTER
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-954-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health