Provider Demographics
NPI:1780915785
Name:BONARDI, STEPHANIE ELYSE (LPC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ELYSE
Last Name:BONARDI
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 1:41 SOUTH MAIN STREET
Mailing Address - Street 2:#37
Mailing Address - City:GRISWOLD
Mailing Address - State:CT
Mailing Address - Zip Code:06351
Mailing Address - Country:US
Mailing Address - Phone:860-886-4850
Mailing Address - Fax:
Practice Address - Street 1:189 STORRS RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06250
Practice Address - Country:US
Practice Address - Phone:860-886-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional