Healthcare Provider Details

I. General information

NPI: 1043196959
Provider Name (Legal Business Name): RACHEL MIRIAM BONAPARTE LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MAIN ST
MIDDLETOWN CT
06457-2732
US

IV. Provider business mailing address

2418 MAIN ST UNIT 6221
ROCKY HILL CT
06067-2573
US

V. Phone/Fax

Practice location:
  • Phone: 203-347-6971
  • Fax: 860-343-7379
Mailing address:
  • Phone: 860-936-8107
  • Fax: 860-936-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15582
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: