Provider Demographics
NPI:1992705917
Name:BUONOMO, MICHAEL CHESTER (MA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHESTER
Last Name:BUONOMO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5781 GLEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:NARVON
Mailing Address - State:PA
Mailing Address - Zip Code:17555-9450
Mailing Address - Country:US
Mailing Address - Phone:717-768-4603
Mailing Address - Fax:717-768-4604
Practice Address - Street 1:5781 GLEN OAKS DR
Practice Address - Street 2:
Practice Address - City:NARVON
Practice Address - State:PA
Practice Address - Zip Code:17555-9450
Practice Address - Country:US
Practice Address - Phone:717-768-4603
Practice Address - Fax:717-768-4604
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005959-L103TC0700X, 101Y00000X, 101YM0800X, 101YP2500X, 103TB0200X, 103TC1900X, 103T00000X, 103TC2200X, 103TM1800X, 305R00000X, 302R00000X, 305S00000X, 302F00000X
PAPS005959-L101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA335793OtherMHN
PABU76559OtherHIGHMARK BS
PA0007133457OtherAETNA
PA1000037020001Medicaid