Provider Demographics
NPI:1669486494
Name:SIMONELLI, BONNIE (LICDC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SIMONELLI
Suffix:
Gender:F
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6785 WALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3024
Mailing Address - Country:US
Mailing Address - Phone:440-457-7474
Mailing Address - Fax:440-230-1965
Practice Address - Street 1:6785 WALLINGS RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3024
Practice Address - Country:US
Practice Address - Phone:440-457-7474
Practice Address - Fax:440-457-7448
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965724101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)