Provider Demographics
NPI:1932897451
Name:DE LIMA SOUZA BONASERA, LAURA BEATRIZ
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BEATRIZ
Last Name:DE LIMA SOUZA BONASERA
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 1:1401 BLAIR MILL RD APT 1421
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4872
Mailing Address - Country:US
Mailing Address - Phone:224-284-4628
Mailing Address - Fax:
Practice Address - Street 1:11921 BOURNEFIELD WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7815
Practice Address - Country:US
Practice Address - Phone:301-578-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician