Provider Demographics
NPI:1275255432
Name:BONSU, LOURIE C (MA)
Entity Type:Individual
Prefix:
First Name:LOURIE
Middle Name:C
Last Name:BONSU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CEDAR ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2646
Mailing Address - Country:US
Mailing Address - Phone:860-665-0200
Mailing Address - Fax:860-540-1609
Practice Address - Street 1:66 CEDAR ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2646
Practice Address - Country:US
Practice Address - Phone:860-665-0200
Practice Address - Fax:860-540-1609
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health