Provider Demographics
NPI:1801195383
Name:BOLOGNINI, NICOLE M (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BOLOGNINI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 US HIGHWAY 46 STE 201
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-2400
Mailing Address - Country:US
Mailing Address - Phone:735-274-5399
Mailing Address - Fax:
Practice Address - Street 1:1850 US HIGHWAY 46 STE 201
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-2400
Practice Address - Country:US
Practice Address - Phone:973-527-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053996001041C0700X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ81-2101002OtherEIN