Provider Demographics
NPI:1831939016
Name:BONILLA ZORRILLA, JIMMY A
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:A
Last Name:BONILLA ZORRILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 WASHINGTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1573
Mailing Address - Country:US
Mailing Address - Phone:814-777-6499
Mailing Address - Fax:
Practice Address - Street 1:233 NEEDHAM ST STE 300
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1502
Practice Address - Country:US
Practice Address - Phone:774-530-0986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health