MEDICARE: DEBORAH L BOLGER LMHC

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
1	101YM0800X	Mental Health Counselor	009339	NY

General Provider Information

NPI Number	:	1881157089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH L BOLGER LMHC

Provider Business Mailing Address
First Line	:	14 RYE RIDGE PLZ STE 244
Second Line	:
City	:	RYE BROOK
State	:	NY
Zip	:	10573-2858
Country	:	US
Telephone Number	:	917-572-3288
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 RYE RIDGE PLZ STE 244
Second Line	:
City	:	RYE BROOK
State	:	NY
Zip	:	10573-2858
Country	:	US
Telephone Number	:	917-572-3288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2019
Last Update Date	:	04/13/2019

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