Healthcare Provider Details

I. General information

NPI: 1447183074
Provider Name (Legal Business Name): LUIS JOEL BONILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 COMMERCIAL ST
HOLYOKE MA
01040-4704
US

IV. Provider business mailing address

933 E COLUMBUS AVE
SPRINGFIELD MA
01105-2509
US

V. Phone/Fax

Practice location:
  • Phone: 413-846-0445
  • Fax: 413-846-0447
Mailing address:
  • Phone: 413-846-0445
  • Fax: 413-846-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: