Healthcare Provider Details

I. General information

NPI: 1942254008
Provider Name (Legal Business Name): ROBERT M BOLLET ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 SEMINOLA BLVD
CASSELBERRY FL
32707-3057
US

IV. Provider business mailing address

100 LAMPLIGHTER RD
ALTAMONTE SPRINGS FL
32714-2041
US

V. Phone/Fax

Practice location:
  • Phone: 407-678-6655
  • Fax: 407-657-7211
Mailing address:
  • Phone: 407-657-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 3058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: