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General NPI Number Information
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NPI Number | 1154522357
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Entity Type | Individual
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Provider Name | CHERYL BONICA PHD
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 3300 MAIN ST STE 4A
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City | SPRINGFIELD
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State | MA
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Zip | 01199-1000
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Country | US
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Telephone | 413-794-1038
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Fax | 413-794-7416
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Provider Business Mailing Address
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Address Line | 3300 MAIN ST STE 4A
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City | SPRINGFIELD
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State | MA
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Zip | 01199-1000
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Country | US
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Telephone | 413-794-1038
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Fax | 413-794-7416
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8131
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License Number State | MA
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