BRIAN ADAM BONILLA (NPI# 1679112569) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679112569 |
| Entity Type | Individual |
| Full Name | BRIAN ADAM BONILLA |
| Credential | LADC |
| Practice Address |
1 Long Wharf Dr Ste 321 New Haven CT 06511-5946 |
| Practice Telephone | 2037814600 |
| Practice Fax Number | 2037814624 |
| Mailing Telephone | 2037814600 |
| Mailing Fax Number | 2037814624 |
| Enumeration Date | 2019-12-26 |
| Last Update Date | 2020-01-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
1359 | CT | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 008092656 | 05 | |
| CT | 008003745 | 05 | |
| CT | 004041000 | 05 |
| Street Address |
1 LONG WHARF DR STE 321 |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06511-5946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487943114 | Brady John Heward | Psychiatry & Neurology | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2011-04-04 |
| 1053918045 | Hannah Kristan | Social Worker | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2020-10-03 |
| 1740816560 | Kelly Mcelreath | Registered Nurse | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2020-03-13 |
| 1538705827 | Gregory George Blakley | Social Worker | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2019-11-21 |
| 1255974770 | Lorianne Meus | Nurse Practitioner | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2019-10-28 |
| 1427690841 | Christine Elizabeth Tirado | Counselor | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2019-10-17 |
| 1932671575 | Michael N Tawiah | Nurse Practitioner | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2018-12-20 |
| 1851862551 | Mami Ngombabu | Registered Nurse | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2018-12-07 |
| 1629543277 | Julia E Greene | Nurse Practitioner | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5991 | 2018-10-10 |
| 1598115750 | Natalie Elena Stahl | Family Medicine | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946 | 2016-06-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194330571 | Allison Elizabeth Pratt | Occupational Therapist | 625 Whitney Ave, Apt 5, New Haeven, CT 06511 | 2020-09-11 |
| 1881213346 | Sarah Bleicher | Registered Nurse | Yale Health, 55 Lock St, New Haven, CT 06511 | 2020-04-14 |
| 1083268395 | Danielle Lee Mcpherson | Pharmacist | Yale New Haven Hospital 55 Park Street, New Haven, CT 06511 | 2019-07-25 |
| 1528533866 | Alexia Levin | Social Worker | 98/100 York St, New Haven, CT 06511 | 2018-10-12 |
| 1861970097 | Orthocare Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 1450 Chapel St Ste Sg15, New Haven, CT 06511 | 2018-07-31 |
| 1609352418 | Susannah Frew | Social Worker | 2 Eld Street, Apt 6, New Haven, CT 06511 | 2018-07-15 |
| 1851881965 | Empowerment Counseling Services, LLC | Counselor | 427 Dixwell Ave, New Haven, CT 06511 | 2018-05-14 |
| 1487173951 | Karine Giasson-gariepy | Student in an Organized Health Care Education/Training Program | Yale University Department of Psychiatry, 300 George Street, Suite 901, New Haven, Ct 06511, New Haven, CT 06511 | 2017-09-15 |
| 1568980696 | Anna Reutenauer | Dentist | 123 York St Ste 4l, New Haven, CT 06511 | 2017-09-08 |
| 1083134753 | Darin Dolezal | Student in an Organized Health Care Education/Training Program | 200 South Frontage Road, Ep2 2nd Floor - 612, Dept of Pathology, New Haven, CT 06511 | 2017-06-23 |
| Find all providers in zip 06511 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700417441 | Prosperity Counseling, LLC | Counselor | 1580 Chapel St, New Haven, CT 06511-4205 | 2020-01-31 |
| 1861050320 | Jewell Cody | Counselor | 171 Lexington Ave, New Haven, CT 06513-4425 | 2019-05-30 |
| 1255820486 | Myra J Best | Counselor | 137 Scranton St Fl 2, New Haven, CT 06511-5339 | 2018-05-03 |
| 1699156356 | Erica Reshard | Counselor | 79 Long Hill Ter, New Haven, CT 06515 | 2015-06-17 |
| 1548695703 | Rena M Owens | Counselor | 1823 Ella Grasso Blvd, New Haven, CT 06511-1603 | 2013-09-06 |
| 1396081980 | Leida Acevedo | Counselor | 570 Elm St, New Haven, CT 06511-4137 | 2012-12-31 |
| 1467708289 | Julia Anne Redman | Counselor | 68 Bradley St, New Haven, CT 06511 | 2012-07-30 |
| 1033402045 | Ethel Bethea | Counselor | 121 Rosette St, New Haven, CT 06519-2427 | 2011-05-24 |
| 1235456203 | Happy Family Clinical Services LLC | Counselor | 530 State Street, New Haven, CT 06511 | 2010-04-29 |
| 1841512100 | Barbara C Moore | Counselor | 1294 Chapel Street, New Haven, CT 06511 | 2010-02-26 |
| Find all providers in NEW HAVEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.