Provider Demographics
NPI:1477890283
Name:BONNER, CELISA K (LCSW)
Entity Type:Individual
Prefix:
First Name:CELISA
Middle Name:K
Last Name:BONNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13787 BELCHER RD S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4065
Mailing Address - Country:US
Mailing Address - Phone:727-723-7532
Mailing Address - Fax:727-797-4733
Practice Address - Street 1:13787 BELCHER ROAD S.
Practice Address - Street 2:SUITE 220
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771
Practice Address - Country:US
Practice Address - Phone:727-723-7532
Practice Address - Fax:727-797-4733
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW99401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical