Provider Demographics
NPI:1821974700
Name:BONAMASSA, SALVATORE (MFT LIMITED PERMIT)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:BONAMASSA
Suffix:
Gender:M
Credentials:MFT LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SHAFTER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2027
Mailing Address - Country:US
Mailing Address - Phone:917-912-8037
Mailing Address - Fax:
Practice Address - Street 1:225 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2969
Practice Address - Country:US
Practice Address - Phone:347-556-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP137270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist