Most Relevant Information
Provider Data
| NPI Number: | 1003365222 |
| Provider Name: | THERESA M. BONANOMI |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/29/2016 |
| Last Updated: | 05/16/2023 |
Provider Practice Location
365 MONTAUK AVE
NEW LONDON
CT
063204700
Practice Location Phone/Fax
| Phone: | 8604445141 |
| Fax: |
Provider Mailing Location
365 MONTAUK AVE
NEW LONDON
CT
063204769
Provider Mailing Phone/Fax
| Phone: | 8604445141 |
| Fax: |