Provider Demographics
NPI:1699199885
Name:BONNEMERE, DAMITA
Entity Type:Individual
Prefix:
First Name:DAMITA
Middle Name:
Last Name:BONNEMERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAMITA
Other - Middle Name:LEE
Other - Last Name:MCGRIFF-HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:17 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4040
Mailing Address - Country:US
Mailing Address - Phone:315-253-9795
Mailing Address - Fax:315-255-0119
Practice Address - Street 1:17 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4040
Practice Address - Country:US
Practice Address - Phone:315-253-9795
Practice Address - Fax:315-255-0119
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist