Healthcare Provider Details

I. General information

NPI: 1962990275
Provider Name (Legal Business Name): BRETT WILLIAM BOLGER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FRANKLIN VILLAGE DR STE 212
FRANKLIN MA
02038-4017
US

IV. Provider business mailing address

274 E MAIN ST STE 5209
NORTON MA
02766-2484
US

V. Phone/Fax

Practice location:
  • Phone: 508-930-8606
  • Fax:
Mailing address:
  • Phone: 508-930-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1159
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: