Healthcare Provider Details

I. General information

NPI: 1922903905
Provider Name (Legal Business Name): BRENDAN BOLAND LCSW, LCADC, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 HENRY ST
BEACON NY
12508-3006
US

IV. Provider business mailing address

14 SPRING ST
NEWBURGH NY
12550-5510
US

V. Phone/Fax

Practice location:
  • Phone: 914-801-8488
  • Fax:
Mailing address:
  • Phone: 617-304-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00403800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131940
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06636800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: