Provider Demographics
NPI:1962554469
Name:FONTAINE, BONNIE ABLAMSKY
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ABLAMSKY
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:
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 268
Mailing Address - Street 2:
Mailing Address - City:CHERRYFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04622-0268
Mailing Address - Country:US
Mailing Address - Phone:207-546-7652
Mailing Address - Fax:
Practice Address - Street 1:83 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHERRYFIELD
Practice Address - State:ME
Practice Address - Zip Code:04622-4204
Practice Address - Country:US
Practice Address - Phone:207-546-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities