Basic Information
| Provider Information | |||||||||
| NPI: | 1235353327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONVISSUTO | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BONVISSUTO | ||||||||
| OtherFirstName: | DONNA | ||||||||
| OtherMiddleName: | GEBURA | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 246 NORTHLAND DR | ||||||||
| Address2: | CATHOLIC CHARITIES SERVICES | ||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442561533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307239615 | ||||||||
| FaxNumber: | 3307648795 | ||||||||
| Practice Location | |||||||||
| Address1: | 246 NORTHLAND DR | ||||||||
| Address2: | CATHOLIC CHARITIES SERVICES | ||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442561533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307239615 | ||||||||
| FaxNumber: | 3307648795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C-0004355 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.