Healthcare Provider Details

I. General information

NPI: 1497788194
Provider Name (Legal Business Name): KRISTEN ELIZABETH BOLOMEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 HEALTH CENTER BLVD STE 2190
ESTERO FL
34135-8133
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6050
  • Fax: 239-343-6051
Mailing address:
  • Phone: 239-343-6050
  • Fax: 239-343-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6975
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 6975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: