Doctor Name: | MR. LIONEL EDWARE BONNEVILLE |
NPI Number: | 1134231202 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CHAPLAIN |
License Number: | |
Business Practice Address: | 421 N Main St Leeds, MA - 010539764 |
Business Phone Number: | 4135844040 |
Business Fax Number: | |
Mailing Address: | 47 Fenway Dr, SPRINGFIELD |
State: | MA |
Postal Code: | 011192431 |
Phone Number: | 4137820475 |
Fax Number: | |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP1600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Pastoral |
Taxonomy Definition: |