1417966961 NPI number — MS. PATRICIA BONENFANT MS, LADC, LPC

Table of content: CASEY HEIDOHRN AUD (NPI 1750867875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417966961 NPI number — MS. PATRICIA BONENFANT MS, LADC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONENFANT
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LADC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417966961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 REICHERT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06880-2642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-981-0770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 REICHERT CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06880-2642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-981-0770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  000038 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 001290 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 349975000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39026 . This is a "UMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06111 . This is a "OXFORD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 00060 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "CONNECTICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: N7V502 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22771 . This is a "MHN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 38520 . This is a "TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A935017 . This is a "BEACON HEALTHCARE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CIGNABH . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 25133 . This is a "COVENTRY HEALTH AMERICAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 004227425 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87726 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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