Provider Demographics
NPI:1497925549
Name:BONANNO, NIAH (BA)
Entity Type:Individual
Prefix:MRS
First Name:NIAH
Middle Name:
Last Name:BONANNO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:NIAH
Other - Middle Name:BONANNO
Other - Last Name:DABNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:80 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1257
Mailing Address - Country:US
Mailing Address - Phone:973-543-5656
Mailing Address - Fax:
Practice Address - Street 1:80 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1257
Practice Address - Country:US
Practice Address - Phone:973-543-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)