NPIMap

Individual provider Active NPI

Michael Chester Buonomo, MA

  • Psychologist
  • Narvon, PA
National Provider Identifier
1992705917
Registry record updated Nov 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS-005959-L Issued in PA
Practice address
5781 Glen Oaks Dr
Narvon, PA 17555-9450
Phone
(717) 768-4603
Fax
(717) 768-4604
NPI assigned
Aug 1, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2007

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

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS-005959-L PA
Counselor 101Y00000X PS-005959-L PA
Mental Health Counselor 101YM0800X PS-005959-L PA
Pastoral Counselor 101YP1600X PS005959-L PA
Professional Counselor 101YP2500X PS-005959-L PA
Cognitive & Behavioral Psychologist 103TB0200X PS-005959-L PA
Counseling Psychologist 103TC1900X PS-005959-L PA
Psychologist 103T00000X PS-005959-L PA Primary
Clinical Child & Adolescent Psychologist 103TC2200X PS-005959-L PA
Intellectual & Developmental Disabilities Psychologist 103TM1800X PS-005959-L PA
Preferred Provider Organization 305R00000X PS-005959-L PA
Health Maintenance Organization 302R00000X PS-005959-L PA
Point of Service 305S00000X PS-005959-L PA
Exclusive Provider Organization 302F00000X PS-005959-L PA

Addresses

Primary practice location

5781 Glen Oaks Dr
Narvon, PA 17555-9450

Mailing address

5781 Glen Oaks Dr
Narvon, PA 17555-9450
Phone (717) 768-4603

Other identifiers 4

IdentifierTypeStateIssuer
335793OtherPAMHN
BU76559OtherPAHIGHMARK BS
0007133457OtherPAAETNA
1000037020001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
PS005959-LPAMDPastoral Counselor
PS-005959-LPAMDExclusive Provider Organization

NPI Registry JSON

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

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195776000000",
    "number": "1992705917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5781 GLEN OAKS DR",
            "city": "NARVON",
            "state": "PA",
            "postal_code": "175559450",
            "telephone_number": "717-768-4603",
            "fax_number": "717-768-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5781 GLEN OAKS DR",
            "city": "NARVON",
            "state": "PA",
            "postal_code": "175559450",
            "telephone_number": "717-768-4603",
            "fax_number": "717-768-4604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUONOMO",
        "first_name": "MICHAEL",
        "middle_name": "CHESTER",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-01",
        "last_updated": "2007-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "PA",
            "license": "PS005959-L",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "PA",
            "license": "PS-005959-L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "335793",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BS",
            "identifier": "BU76559",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007133457",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000037020001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Narvon, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; 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.