Healthcare Provider Details

I. General information

NPI: 1063628717
Provider Name (Legal Business Name): DONALD T. BOBOLA PMHCNS - BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAY ST
SOUTH ATTLEBORO MA
02703-5520
US

IV. Provider business mailing address

200 MAY ST
SOUTH ATTLEBORO MA
02703-5520
US

V. Phone/Fax

Practice location:
  • Phone: 508-761-8500
  • Fax: 508-761-8500
Mailing address:
  • Phone: 508-761-8500
  • Fax: 508-761-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN208066
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: