Provider Demographics
NPI:1760521397
Name:BONANNO, DEBORAH ANN (PSYD, MSW)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:BONANNO
Suffix:
Gender:F
Credentials:PSYD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 CREEKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4330
Mailing Address - Country:US
Mailing Address - Phone:407-484-9877
Mailing Address - Fax:
Practice Address - Street 1:2040 WINTER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9347
Practice Address - Country:US
Practice Address - Phone:407-484-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2414103TC0700X
FLPY 8031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical