Deanna Bonaventura, LPC
Individual provider Active NPI Professional Counselor · North Haven, CT
NPI 1922515196 · NPPES record last updated Feb 14, 2018
Key facts
- NPI
- 1922515196
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 3305 (CT)
- Practice address
- 352 State St
North Haven, CT 06473-3108 - Phone
- (203) 781-4600
- Fax
- (203) 498-3820
- NPI assigned
- Jan 9, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3305 | CT | Yes |
Addresses
Primary practice location
352 State St
North Haven, CT 06473-3108
Mailing address
1 Long Wharf Dr
New Haven, CT 06511-5991
Phone (203) 781-4600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008056168 | Medicaid | CT | |
| 008077565 | Medicaid | CT | |
| 004082286 | Medicaid | CT | |
| 008022626 | Medicaid | CT | |
| 500000315 | Medicaid | CT |
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All providers in North Haven, CT · Professional Counselor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.