Provider Demographics
NPI:1083947543
Name:BONELLI, VICTORIA (MA, LMFT, LMHC, NBCC)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:BONELLI
Suffix:
Gender:F
Credentials:MA, LMFT, LMHC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 MAITLAND CENTER COMMONS BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7435
Mailing Address - Country:US
Mailing Address - Phone:407-788-8600
Mailing Address - Fax:
Practice Address - Street 1:1061 MAITLAND CENTER COMMONS BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7435
Practice Address - Country:US
Practice Address - Phone:407-788-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6608101YM0800X
FLMT 1904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health