Active NPI
Nicolas Alonzo Bolanos, M.ED., ED.S.
- Counselor
- Fort Myers, FL
National Provider Identifier
1932442837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- IMH9380
- Practice address
- 4150 Ford Street Extension
Fort Myers, FL 33916 - Phone
- (239) 461-8388
- Fax
- (239) 790-5121
- NPI assigned
- Mar 29, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | IMH9380 | FL | Primary |
Addresses
Primary practice location
4150 Ford Street Extension
Fort Myers, FL 33916
Mailing address
4150 Ford Street Extention
Fort Myers, FL 33916
Phone (239) 461-8388
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH9380 | FL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364515200000",
"number": "1932442837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4150 FORD STREET EXTENTION",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "33916",
"telephone_number": "239-461-8388",
"fax_number": "239-790-5121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4150 FORD STREET EXTENSION",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "33916",
"telephone_number": "239-461-8388",
"fax_number": "239-790-5121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLANOS",
"first_name": "NICOLAS",
"middle_name": "ALONZO",
"name_prefix": "Mr.",
"credential": "M.ED., ED.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-29",
"last_updated": "2013-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "FL",
"license": "IMH9380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.