Individual
MEGAN BONAVENTURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
512 BIRDSONG LN, BROADWAY, VA 22815-3637
(315) 447-6244
Mailing address
512 BIRDSONG LN, BROADWAY, VA 22815-3637
(315) 447-6244
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
PPS-0603571
VA
Other
Enumeration date
12/16/2021
Last updated
12/16/2021
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