Healthcare Provider Details

I. General information

NPI: 1427194539
Provider Name (Legal Business Name): BOLTON BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NOTCH RD
BOLTON CT
06043-7431
US

IV. Provider business mailing address

108 NOTCH RD
BOLTON CT
06043-7431
US

V. Phone/Fax

Practice location:
  • Phone: 860-643-1569
  • Fax: 860-647-8452
Mailing address:
  • Phone: 860-643-1569
  • Fax: 860-647-8452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN GOODWIN
Title or Position: DIRECTOR OF PUPIL SERVICES
Credential:
Phone: 860-643-1569