Active NPI
Corien Bologna, LCAT, ATR-BC
- Art Therapist
- Port Jefferson, NY
National Provider Identifier
1750128906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Art Therapist
- License
- 001744-01
- Practice address
- 1000 Main St
Port Jefferson, NY 11777-2250 - Phone
- (631) 682-9507
- NPI assigned
- Jul 12, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | 2936702 | NY | |
| Art Therapist | 221700000X | 001744-01 | NY | Primary |
Addresses
Primary practice location
1000 Main St
Port Jefferson, NY 11777-2250
Mailing address
15 Parkridge Cir
Port Jefferson Station, NY 11776-3418
Phone (631) 682-9507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2936702 | NY | MD | School Counselor |
| 001744-01 | NY | MD | Art Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722643200000",
"number": "1750128906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 PARKRIDGE CIR",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117763418",
"telephone_number": "631-682-9507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 MAIN ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772250",
"telephone_number": "631-682-9507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLOGNA",
"first_name": "CORIEN",
"name_prefix": "Mrs.",
"credential": "LCAT, ATR-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-12",
"last_updated": "2024-08-03",
"certification_date": "2024-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "NY",
"license": "2936702",
"primary": false
},
{
"code": "221700000X",
"taxonomy_group": "",
"desc": "Art Therapist",
"state": "NY",
"license": "001744-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.