Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1134231202 |
---|---|
Provider Name | Mr. Lionel Edware Bonneville |
First Address | Springfield, MA 01119-2431 |
Second Address | Leeds, MA 01053-9764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |