Provider Demographics
NPI:1376674275
Name:MULLANEY-BONILLA, COLLEEN A (LPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:MULLANEY-BONILLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3010
Mailing Address - Country:US
Mailing Address - Phone:860-826-7247
Mailing Address - Fax:
Practice Address - Street 1:509 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1907
Practice Address - Country:US
Practice Address - Phone:860-296-2121
Practice Address - Fax:860-296-1197
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000514101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor