Active NPI
Nancy Claire Bologna, PHD, MS, LP
- Clinical Psychologist
- Eden Prairie, MN
National Provider Identifier
1790089878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP1470
- Practice address
- 7525 Mitchell Rd
Suite 200
Eden Prairie, MN 55344-1959 - Phone
- (612) 360-8305
- NPI assigned
- Jan 4, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP1470 | MN | Primary |
Addresses
Primary practice location
7525 Mitchell Rd
Suite 200
Eden Prairie, MN 55344-1959
Mailing address
7525 Mitchell Rd
Suite 200
Eden Prairie, MN 55344-1959
Phone (612) 360-8305
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 14, 2022 through Feb 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP1470 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294099200000",
"number": "1790089878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7525 MITCHELL RD",
"address_2": "SUITE 200",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553441959",
"telephone_number": "612-360-8305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7525 MITCHELL RD",
"address_2": "SUITE 200",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553441959",
"telephone_number": "612-360-8305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLOGNA",
"first_name": "NANCY",
"middle_name": "CLAIRE",
"name_prefix": "Dr.",
"credential": "PHD, MS, LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-04",
"last_updated": "2011-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP1470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.