| Doctor Name: | MS. MARYELLEN MARLENE BONACCI |
| NPI Number: | 1265514939 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 6801087694 |
| Business Practice Address: | 438 County Road 612 Ne Kalkaska, MI - 496468577 |
| Business Phone Number: | 2312585565 |
| Business Fax Number: | |
| Mailing Address: | 3017 Raymo Rd Sw, SOUTH BOARDMAN |
| State: | MI |
| Postal Code: | 496809438 |
| Phone Number: | 2312585565 |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6801087694 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |