Provider Demographics
NPI:1417719873
Name:BONAGURO, ELIANA (PSYCHOTHERAPIST)
Entity Type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:BONAGURO
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23161 FASHION DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2587
Mailing Address - Country:US
Mailing Address - Phone:917-532-5570
Mailing Address - Fax:
Practice Address - Street 1:23161 FASHION DR UNIT 202
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2587
Practice Address - Country:US
Practice Address - Phone:917-532-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health