Megan Bonaventura

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

PPS-0603571 Issued in VA

Practice address

512 Birdsong LN
Broadway, VA 22815-3637

Phone

(315) 447-6244

NPI assigned

Dec 16, 2021

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 16, 2021.

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1104585173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 BIRDSONG LN",
            "city": "BROADWAY",
            "state": "VA",
            "postal_code": "228153637",
            "telephone_number": "315-447-6244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 BIRDSONG LN",
            "city": "BROADWAY",
            "state": "VA",
            "postal_code": "228153637",
            "telephone_number": "315-447-6244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONAVENTURA",
        "first_name": "MEGAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "VA",
            "license": "PPS-0603571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Elizabeth Baker, MS, PT
• Robin Bell, RPH
• George Alexander Bentrem II, M.D.
• Bickham Counseling PLLC
• Joanna Bickham, LPC
• Broadway Drug Center, LLC
• Broadway Drug Center, LLC
• Broadway Family Practice, PC
• Bryan J Callahan, PT, DPT
• Jacob Austin Canfield, MD

• All providers in Broadway, VA
• School Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.