Provider Demographics
NPI:1780439042
Name:BONETT, MANUELA
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:BONETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LEVESQUE AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1135
Mailing Address - Country:US
Mailing Address - Phone:860-671-9644
Mailing Address - Fax:
Practice Address - Street 1:450 COLUMBUS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1842
Practice Address - Country:US
Practice Address - Phone:860-233-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist