Healthcare Provider Details

I. General information

NPI: 1962176404
Provider Name (Legal Business Name): ACCLAIM ASSESSMENT CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 08/08/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 TAMARACK AVE STE 201
SOUTH WINDSOR CT
06074-5559
US

IV. Provider business mailing address

PO BOX 583
SOUTH WINDSOR CT
06074-0583
US

V. Phone/Fax

Practice location:
  • Phone: 860-539-6779
  • Fax: 860-432-8035
Mailing address:
  • Phone: 860-539-6779
  • Fax: 860-432-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN BONANNO
Title or Position: OWNER
Credential: PSY.D.
Phone: 860-539-6779