Carly Bolli
Individual provider Active NPI Clinical Social Worker · Brown Deer, WI
NPI 1801437116 · NPPES record last updated Oct 8, 2019
Key facts
- NPI
- 1801437116
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Practice address
- 3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220 - Phone
- (414) 540-2170
- NPI assigned
- Oct 8, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Yes |
Addresses
Primary practice location
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Mailing address
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Phone (414) 540-2170
NPI Registry JSON
{
"created_epoch": "1570492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570492800000",
"number": "1801437116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 W BROWN DEER RD STE 200",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532091220",
"telephone_number": "414-540-2170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 W BROWN DEER RD STE 200",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532091220",
"telephone_number": "414-540-2170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLLI",
"first_name": "CARLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-08",
"last_updated": "2019-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brown Deer, WI
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All providers in Brown Deer, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.