Healthcare Provider Details

I. General information

NPI: 1164791547
Provider Name (Legal Business Name): ACCLAIM BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 TAMARACK AVENUE
SOUTH WINDSOR CT
06074
US

IV. Provider business mailing address

24 FRAZER FIR RD
SOUTH WINDSOR CT
06074-1654
US

V. Phone/Fax

Practice location:
  • Phone: 860-539-6779
  • Fax:
Mailing address:
  • Phone: 860-432-1160
  • Fax: 860-432-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002823
License Number StateCT

VIII. Authorized Official

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