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NPI Code Detail

MEDICARE: MS. AMY MAE BOLTON

MEDICARE: MS. AMY MAE BOLTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1598188583
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY MAE BOLTON
Provider Business Mailing Address
First Line : 344 WELLMAN AVE
Second Line :
City : NORTH CHELMSFORD
State : MA
Zip : 01863-1350
Country : US
Telephone Number : 339-222-1549
Fax Number : 978-256-0667
Provider Business Practice Location Address
First Line : 21 GLEN AVE
Second Line :
City : CHELMSFORD
State : MA
Zip : 01824-2858
Country : US
Telephone Number : 978-256-0667
Fax Number : 978-256-5567
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2014
Last Update Date : 01/27/2014

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