Provider Demographics
NPI:1710562848
Name:LOLA BROGNANO, LCSW, LLC
Entity Type:Organization
Organization Name:LOLA BROGNANO, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGNANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-860-1938
Mailing Address - Street 1:491 TEAL LN APT A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4742
Mailing Address - Country:US
Mailing Address - Phone:920-860-1938
Mailing Address - Fax:
Practice Address - Street 1:1882 CAPITAL CIR NE STE 201
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4568
Practice Address - Country:US
Practice Address - Phone:850-888-0136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024870200Medicaid