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: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 BRADFORD ST
BRISTOL RI
02809-2367
US

IV. Provider business mailing address

279N MAIN ST
FALL RIVER MA
02720-2320
US

V. Phone/Fax

Practice location:
  • Phone: 401-396-9984
  • Fax: 401-396-9945
Mailing address:
  • Phone: 508-679-0033
  • Fax: 508-679-0037

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: