Provider Demographics
NPI:1598271850
Name:BONANNO, SUMA SIDDHARAM
Entity Type:Individual
Prefix:MRS
First Name:SUMA
Middle Name:SIDDHARAM
Last Name:BONANNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BEAVER POND RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78 SOUTH ST STE L1
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-2119
Practice Address - Country:US
Practice Address - Phone:774-847-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical