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General NPI Number Information
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NPI Number | 1528394376
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Entity Type | Organization
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Legal Business Name | MELISSA BONASERA, MD, LLC
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 103 S MAIN ST
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City | NEWTOWN
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State | CT
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Zip | 06470-2372
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Country | US
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Telephone | 203-364-0660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 322
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City | NEWTOWN
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State | CT
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Zip | 06470-0322
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Country | US
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Telephone | 203-364-0660
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MELISSA BONASERA
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Credential |
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Telephone | 203-364-0660
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 045981
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 045981
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License Number State | CT
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