Provider Demographics
NPI:1750634887
Name:BOLOGNA, SARAH L (LMSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:BOLOGNA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 MOOREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-9519
Mailing Address - Country:US
Mailing Address - Phone:734-945-4631
Mailing Address - Fax:
Practice Address - Street 1:532 RAMBOW DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3549
Practice Address - Country:US
Practice Address - Phone:734-559-3540
Practice Address - Fax:734-667-3925
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker