Provider Demographics
NPI:1164791547
Name:ACCLAIM BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:ACCLAIM BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANNO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-539-6779
Mailing Address - Street 1:24 FRAZER FIR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1654
Mailing Address - Country:US
Mailing Address - Phone:860-432-1160
Mailing Address - Fax:860-432-8035
Practice Address - Street 1:2400 TAMARACK AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074
Practice Address - Country:US
Practice Address - Phone:860-539-6779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002823103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty