Provider Demographics
NPI:1396975405
Name:BOLGER, DEBRA J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J
Last Name:BOLGER
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 1:13366 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2722
Mailing Address - Country:US
Mailing Address - Phone:305-332-5312
Mailing Address - Fax:
Practice Address - Street 1:13366 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2722
Practice Address - Country:US
Practice Address - Phone:305-332-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 8482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW 8482OtherL.C.S.W.