Healthcare Provider Details

I. General information

NPI: 1437238730
Provider Name (Legal Business Name): WILLIAM EDWARD BOLDUC LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ARMY PENTAGON
WASHINGTON DC
20310-5810
US

IV. Provider business mailing address

7700 ARLINGTON BLVD
FALLS CHURCH VA
22042-2929
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-8878
  • Fax:
Mailing address:
  • Phone: 581-225-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC8125
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: