Provider Demographics
NPI:1922515196
Name:BONAVENTURA, DEANNA (LPC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:BONAVENTURA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5991
Mailing Address - Country:US
Mailing Address - Phone:203-781-4600
Mailing Address - Fax:203-781-4624
Practice Address - Street 1:352 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3108
Practice Address - Country:US
Practice Address - Phone:203-781-4600
Practice Address - Fax:203-498-3820
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008056168Medicaid
CT008077565Medicaid
CT004082286Medicaid
CT008022626Medicaid
CT500000315Medicaid