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General NPI Number Information
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NPI Number | 1902956089
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Entity Type | Individual
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Provider Name | SARA INES BONILLA LMHC, CCM
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 10 CABOT RD STE 205
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City | MEDFORD
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State | MA
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Zip | 02155-5173
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Country | US
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Telephone | 781-202-6524
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Fax |
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Provider Business Mailing Address
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Address Line | 22 9TH ST APT 104
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City | MEDFORD
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State | MA
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Zip | 02155-5139
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Country | US
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Telephone | 781-816-3130
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CCM4242685
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC7737
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License Number State | MA
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