Provider Demographics
NPI:1669657086
Name:BONASERA, MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:BONASERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BONASERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:HAWLEYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06440-0756
Mailing Address - Country:US
Mailing Address - Phone:203-682-0907
Mailing Address - Fax:203-682-0258
Practice Address - Street 1:33 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4303
Practice Address - Country:US
Practice Address - Phone:203-682-0907
Practice Address - Fax:203-682-0258
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0459812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry