BRIAN ADAM BONILLA LADC LPC NPI 1679112569

NPI Information

NPI: 1679112569
Provider Name: BRIAN ADAM BONILLA, LADC, LPC
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

PECOS Registration: Yes

Address:
1 LONG WHARF DR STE 321
NEW HAVEN, CT
ZIP 06511
Phone: (203) 781-4600
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Brian Adam Bonilla, LADC, LPC is a professional counselor in New Haven, CT. Brian Adam Bonilla, LADC, LPC NPI is 1679112569. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1 LONG WHARF DR STE 321
NEW HAVEN, CT
ZIP 06511-946
Phone: (203) 781-4600
Fax: (203) 781-4624

The NPI 1679112569 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 12/26/2019 and was last updated on 3/16/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	1359	CONNECTICUT	No
2	101YP2500X	Counselor	Professional	5365	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	008092656	MEDICAID	CONNECTICUT
2	004041000	MEDICAID	CONNECTICUT
3	008003745	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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