Provider Demographics
NPI:1912473562
Name:NIELSEN, BONNIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2675 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3109
Mailing Address - Country:US
Mailing Address - Phone:727-586-4432
Mailing Address - Fax:
Practice Address - Street 1:2675 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3109
Practice Address - Country:US
Practice Address - Phone:727-586-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW155001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical