Provider Demographics
NPI:1952065765
Name:STELL, BONNY G (MA)
Entity type:Individual
Prefix:MISS
First Name:BONNY
Middle Name:G
Last Name:STELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:BONNY
Other - Middle Name:G
Other - Last Name:GARDNER
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:490 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1297
Mailing Address - Country:US
Mailing Address - Phone:585-922-2686
Mailing Address - Fax:
Practice Address - Street 1:490 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1297
Practice Address - Country:US
Practice Address - Phone:585-922-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health