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General NPI Number Information
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NPI Number | 1124248182
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Entity Type | Individual
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Provider Name | JAMEL CHARLOTTE BONELLO L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 402 E MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06702-1701
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Country | US
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Telephone | 203-755-1143
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Fax | 203-753-3274
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Provider Business Mailing Address
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Address Line | PO BOX 764
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City | BANTAM
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State | CT
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Zip | 06750-0764
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Country | US
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Telephone | 860-480-0085
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006839
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License Number State | CT
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