Individual
BONNIE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, QS
Contact information
Practice address
1729 NW SAINT LUCIE WEST BLVD # 1276, PORT SAINT LUCIE, FL 34986-2501
(561) 412-9281
(620) 522-8594
Mailing address
1729 NW SAINT LUCIE WEST BLVD # 1276, PORT SAINT LUCIE, FL 34986-2501
(561) 412-9281
(620) 522-8594
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
SW15096
FL
104100000X
Social Worker
SW15096
FL
1041C0700X
Clinical Social Worker
SW15096
FL
171M00000X
Case Manager/Care Coordinator
SW15096
FL
Other
Enumeration date
08/20/2018
Last updated
11/25/2025
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