Provider Demographics
NPI:1235767609
Name:CAMPAGNA BONOMO, SAMANTHA (NCC, LMFT, LMHC,)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CAMPAGNA BONOMO
Suffix:
Gender:
Credentials:NCC, LMFT, LMHC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11370 SW 232ND TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6000
Mailing Address - Country:US
Mailing Address - Phone:305-335-0254
Mailing Address - Fax:
Practice Address - Street 1:11370 SW 232ND TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6000
Practice Address - Country:US
Practice Address - Phone:305-335-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100938104100000X
171M00000X
FLMH20406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator