Provider Demographics
NPI:1154821783
Name:SHELLEY GALASSO BONANNO & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SHELLEY GALASSO BONANNO & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANNO
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:586-917-4001
Mailing Address - Street 1:1019 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6779
Mailing Address - Country:US
Mailing Address - Phone:586-917-4001
Mailing Address - Fax:586-412-5836
Practice Address - Street 1:1019 HAYNES ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6779
Practice Address - Country:US
Practice Address - Phone:586-917-4001
Practice Address - Fax:586-412-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty