Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 002824 | CT |
NPI | 1386072270 |
---|---|
Provider Name | Dr. Marc Bono |
First Address | Branford, CT 06405-2922 |
Second Address | Branford, CT 06405-2922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2013 |
Last Update Date | 31/10/2013 |