Basic Information
| Provider Information | |||||||||
| NPI: | 1790961076 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BUONOMO | ||||||||
| FirstName: | LAURA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 264 WEBSTER AVE APT 701 | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112301212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188692678 | ||||||||
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| Practice Location | |||||||||
| Address1: | 348 13TH ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112155004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187882461 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 05/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | 000459-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist |
No ID Information.