Marc Bonaguide, LCSW
Individual provider Active NPI Clinical Social Worker · Weatogue, CT
NPI 1003341272 · NPPES record last updated Apr 25, 2017
Key facts
- NPI
- 1003341272
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 006548 (CT)
- Practice address
- 10 Sunrise Ter
Weatogue, CT 06089-9755 - Phone
- (860) 951-1240
- NPI assigned
- Apr 25, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2004
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
50 Albany Tpke
BLDG 4
Canton, CT 06019-2516
Phone (860) 951-1240
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220908002795 | CT | Practitioner - Clinical Social Worker | 0749664803 | Practice locations: Canton, CT |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006548 | CT | MD | Clinical Social Worker |
| 6548 | CT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marc Bonaguide LLC | Current | Accepting new patients |
Locations
50 Albany Tpke
Bldg 4
Canton, CT 06019
Phone (860) 387-7868
50 Albany Tpke
Ste 4025
Canton, CT 06019
Phone (860) 951-1240
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 006548 | CT | Yes |
Addresses
Primary practice location
10 Sunrise Ter
Weatogue, CT 06089-9755
Mailing address
10 Sunrise Ter
Weatogue, CT 06089-9755
Other providers in Weatogue, CT
- Rachael Balboni
- Richard H Bason
- Sophia Diana Beason-Brown
- Kim Lee Bergeron-Duncan
- Bethel Health Management Associates, Inc.
- Matthew Burns
- Matthew Chere
- Fletcher Comment
- Karen Maria Corriveau
- Tricia Rose Cummings
All providers in Weatogue, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.