Healthcare Provider Details

I. General information

NPI: 1205161221
Provider Name (Legal Business Name): JOANNE C BONAMI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 CRESCENT PARK DR FL 1
RIVERVIEW FL
33578-3625
US

IV. Provider business mailing address

13194 US HIGHWAY 301 S STE 375
RIVERVIEW FL
33578-7410
US

V. Phone/Fax

Practice location:
  • Phone: 813-937-9310
  • Fax:
Mailing address:
  • Phone: 813-937-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: