Provider Demographics
NPI:1528341740
Name:ALESSANDRA BUONOPANE MD PSYCHIATRY AND ADDICTION LLC
Entity type:Organization
Organization Name:ALESSANDRA BUONOPANE MD PSYCHIATRY AND ADDICTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALESSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUONOPANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-640-9185
Mailing Address - Street 1:192 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3727
Mailing Address - Country:US
Mailing Address - Phone:860-347-2366
Mailing Address - Fax:860-347-1525
Practice Address - Street 1:192 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3727
Practice Address - Country:US
Practice Address - Phone:860-347-2366
Practice Address - Fax:860-347-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039423261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH52712Medicaid
CTH52712Medicare PIN