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General NPI Number Information
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NPI Number | 1982550950
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Entity Type | Organization
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Legal Business Name | BONANNO, ANDERSON & MARCIN, PROF. CORP.
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 3010 COLBY ST STE 212
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City | BERKELEY
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State | CA
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Zip | 94705-2059
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Country | US
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Telephone | 650-417-3637
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Fax | 618-464-1208
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Provider Business Mailing Address
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Address Line | 2108 N ST STE N
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO / TREASURER
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Name | DR. PHILIP BONANNO
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Credential | MD
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Telephone | 201-960-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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