David Bonanno, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

CT002860 Issued in CT

Practice address

20 Research Pkwy
Suite C
Old Saybrook, CT 06475-4214

Phone

(800) 370-3651

Fax

(860) 510-0030

NPI assigned

Jun 6, 2008

Last updated

Jun 6, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212710400000",
    "number": "1780843540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 RESEARCH PKWY",
            "address_2": "SUITE C",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064754214",
            "telephone_number": "800-370-3651",
            "fax_number": "860-510-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 RESEARCH PKWY",
            "address_2": "SUITE C",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064754214",
            "telephone_number": "800-370-3651",
            "fax_number": "860-510-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONANNO",
        "first_name": "DAVID",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2008-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "CT002860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Judith F. Bloom, LICSW
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• Brittany Sanchez, LPC
• Jane Brockway, PA

• Clinical Psychologist in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; 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.