Provider Demographics
NPI:1326341942
Name:BONDONNO, LAURA MELANIA (MFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MELANIA
Last Name:BONDONNO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GLEN COVE PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7171
Mailing Address - Country:US
Mailing Address - Phone:707-647-7007
Mailing Address - Fax:707-647-7007
Practice Address - Street 1:1255 TREAT BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-7968
Practice Address - Country:US
Practice Address - Phone:877-823-0909
Practice Address - Fax:707-647-7007
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist