Provider Demographics
NPI:1124206982
Name:BOHONOWICZ, MATTHEW PAUL (LPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PAUL
Last Name:BOHONOWICZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WINDERMERE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2426
Mailing Address - Country:US
Mailing Address - Phone:860-890-8689
Mailing Address - Fax:
Practice Address - Street 1:117 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5246
Practice Address - Country:US
Practice Address - Phone:860-890-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional