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NPI Code Detail

MEDICARE: MRS. BONNIE NIELSEN LCSW

MEDICARE: MRS. BONNIE NIELSEN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCSW15500FL

General Provider Information

NPI Number : 1912473562
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BONNIE NIELSEN LCSW
Provider Business Mailing Address
First Line : 2675 TAMPA RD
Second Line :
City : PALM HARBOR
State : FL
Zip : 34684-3109
Country : US
Telephone Number : 727-586-4432
Fax Number :
Provider Business Practice Location Address
First Line : 2675 TAMPA RD
Second Line :
City : PALM HARBOR
State : FL
Zip : 34684-3109
Country : US
Telephone Number : 727-586-4432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2018
Last Update Date : 10/22/2018

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