Individual
DANIEL LOUIS BOLOGNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
840 BREVARD AVE, ROCKLEDGE, FL 32955-2149
(321) 632-5792
Mailing address
840 BREVARD AVE, ROCKLEDGE, FL 32955-2149
(321) 632-5792
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW000254
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060332500
—
FL
01
—
275862
WELLCARE
FL
01
—
62-40039
UNITED HEALTH CARE
FL
Enumeration date
03/16/2007
Last updated
06/09/2009
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