Provider Demographics
NPI:1871645895
Name:BONACCORSO, CANDELA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CANDELA
Middle Name:
Last Name:BONACCORSO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MADISON AVE RM 608
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0800
Mailing Address - Country:US
Mailing Address - Phone:347-921-3752
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE RM 608
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0800
Practice Address - Country:US
Practice Address - Phone:347-921-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical