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General NPI Number Information
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NPI Number | 1124071063
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Entity Type | Individual
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Provider Name | COLLEEN ELAINE BOLDUC MSW
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 41 DEPOT ST
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City | BRIDGTON
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State | ME
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Zip | 04009-1212
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Country | US
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Telephone | 207-647-0954
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Fax | 207-647-0953
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Provider Business Mailing Address
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Address Line | PO BOX 84
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City | BRIDGTON
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State | ME
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Zip | 04009-0084
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Country | US
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Telephone | 207-647-0954
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Fax | 207-647-0953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1339
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4381
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License Number State | ME
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