Provider Demographics
NPI:1417966961
Name:BONENFANT, PATRICIA (MS, LADC, LPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:BONENFANT
Suffix:
Gender:F
Credentials:MS, LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 REICHERT CIR
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2642
Mailing Address - Country:US
Mailing Address - Phone:203-981-0770
Mailing Address - Fax:
Practice Address - Street 1:23 REICHERT CIR
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2642
Practice Address - Country:US
Practice Address - Phone:203-981-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000038101YA0400X
CT001290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
349975000OtherMAGELLAN
39026OtherUMR
AR06111OtherOXFORD
CT00060OtherANTHEM
UT87726OtherCONNECTICARE
N7V502OtherEMPIRE
KY22771OtherMHN
SC38520OtherTRICARE
TX60054OtherAETNA
A935017OtherBEACON HEALTHCARE OPTIONS
TNCIGNABHOtherCIGNA
KY25133OtherCOVENTRY HEALTH AMERICAN
CT004227425Medicaid
87726OtherUNITED HEALTHCARE