Doctor Name: | JENNIFER LEE BOULDRY |
NPI Number: | 1164824207 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW/C |
License Number: | MC15031 |
Business Practice Address: | 67 Eustis Pkwy Waterville, ME - 049015173 |
Business Phone Number: | 2078732136 |
Business Fax Number: | |
Mailing Address: | 67 Eustis Pkwy, WATERVILLE |
State: | ME |
Postal Code: | 049015173 |
Phone Number: | 2078732136 |
Fax Number: | |
NPI Enumeration Date: | 09/19/2014 |
NPI Last Update Date: | 09/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | MC15031 |
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 |