Healthcare Provider Details

I. General information

NPI: 1235767609
Provider Name (Legal Business Name): SAMANTHA CAMPAGNA BONOMO N.C.C., LMFT, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 SW 232ND TER
HOMESTEAD FL
33032-6000
US

IV. Provider business mailing address

11370 SW 232ND TER
HOMESTEAD FL
33032-6000
US

V. Phone/Fax

Practice location:
  • Phone: 786-519-1619
  • Fax:
Mailing address:
  • Phone: 305-335-0254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4258
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: