Provider Demographics
NPI:1972650141
Name:BONSIGNORE-BERRY, STEPHEN CHARLES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:BONSIGNORE-BERRY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:C
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:209 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2926
Mailing Address - Country:US
Mailing Address - Phone:508-584-2291
Mailing Address - Fax:508-584-3480
Practice Address - Street 1:209 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2926
Practice Address - Country:US
Practice Address - Phone:508-584-2291
Practice Address - Fax:508-584-3480
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6229103TC0700X
OH4586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO5402Medicare ID - Type Unspecified