Doctor Name: | MR. MARC L BONIN |
NPI Number: | 1053430074 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED. |
License Number: | |
Business Practice Address: | 100 South St Southbridge, MA - 015504051 |
Business Phone Number: | 5087659771 |
Business Fax Number: | |
Mailing Address: | 14 Blue Herron Rd, DUDLEY |
State: | MA |
Postal Code: | 015716035 |
Phone Number: | 5089432182 |
Fax Number: | |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |