Provider Demographics
NPI:1154522357
Name:BONICA, CHERYL (PHD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BONICA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MAIN ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1000
Mailing Address - Country:US
Mailing Address - Phone:413-794-1038
Mailing Address - Fax:413-794-7416
Practice Address - Street 1:3300 MAIN ST STE 4A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1000
Practice Address - Country:US
Practice Address - Phone:413-794-1038
Practice Address - Fax:413-794-7416
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8131103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical