Individual
MICHAEL CHESTER BUONOMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
5781 GLEN OAKS DR, NARVON, PA 17555-9450
(717) 768-4603
(717) 768-4604
Mailing address
5781 GLEN OAKS DR, NARVON, PA 17555-9450
(717) 768-4603
(717) 768-4604
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PS-005959-L
PA
101YM0800X
Mental Health Counselor
PS-005959-L
PA
101YP1600X
Pastoral Counselor
PS005959-L
PA
101YP2500X
Professional Counselor
PS-005959-L
PA
103T00000X
Psychologist
Primary
PS-005959-L
PA
103TB0200X
Cognitive & Behavioral Psychologist
PS-005959-L
PA
103TC0700X
Clinical Psychologist
PS-005959-L
PA
103TC1900X
Counseling Psychologist
PS-005959-L
PA
103TC2200X
Clinical Child & Adolescent Psychologist
PS-005959-L
PA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PS-005959-L
PA
302F00000X
Exclusive Provider Organization
PS-005959-L
PA
302R00000X
Health Maintenance Organization
PS-005959-L
PA
305R00000X
Preferred Provider Organization
PS-005959-L
PA
305S00000X
Point of Service
PS-005959-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007133457
AETNA
PA
05
—
1000037020001
—
PA
01
—
335793
MHN
PA
01
—
BU76559
HIGHMARK BS
PA
Enumeration date
08/01/2005
Last updated
11/23/2007
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