Healthcare Provider Details

I. General information

NPI: 1477506020
Provider Name (Legal Business Name): STACIE E BUONAURA MSW, LCSW, CRAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3318
US

IV. Provider business mailing address

1500 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3318
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-4151
  • Fax: 573-778-4156
Mailing address:
  • Phone: 573-686-4151
  • Fax: 573-778-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2006006713
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2006006713
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: