Provider Demographics
NPI:1124248182
Name:BONELLO, JAMEL CHARLOTTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JAMEL
Middle Name:CHARLOTTE
Last Name:BONELLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-0764
Mailing Address - Country:US
Mailing Address - Phone:860-480-0085
Mailing Address - Fax:
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1701
Practice Address - Country:US
Practice Address - Phone:203-755-1143
Practice Address - Fax:203-753-3274
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0068391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CTPENDINGOtherMHN
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTPENDINGOtherMHN TRICARENORTH
CT12207576OtherCAQH
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTD339123 WATERBURYOtherBEACON HEALTH
CT008030411Medicaid
CT060669107OtherOPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT060669107OtherUBH OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY
CTPENDINGOtherMHN