Doctor Name: | MICHELLE H. BOLEN |
NPI Number: | 1154330975 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | LC4444 |
Business Practice Address: | 744 Roosevelt Trl Ste 302a Windham, ME - 040625281 |
Business Phone Number: | 2078927797 |
Business Fax Number: | 2078927797 |
Mailing Address: | 744 Roosevelt Trl Ste 302a, WINDHAM |
State: | ME |
Postal Code: | 040625281 |
Phone Number: | 2078927797 |
Fax Number: | 2078927797 |
NPI Enumeration Date: | 08/08/2006 |
NPI Last Update Date: | 10/20/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LC4444 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |