Provider Demographics
NPI:1376386193
Name:BOLOGNA, KERRI LYNN
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:BOLOGNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 ASPETUCK TRL
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2880
Mailing Address - Country:US
Mailing Address - Phone:203-450-1122
Mailing Address - Fax:
Practice Address - Street 1:1000 BRIDGEPORT AVE # 405
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4660
Practice Address - Country:US
Practice Address - Phone:203-993-6592
Practice Address - Fax:475-203-3328
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician