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General NPI Number Information
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NPI Number | 1366048332
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Entity Type | Individual
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Provider Name | ALYSSIA NIOBE BOLDIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 5331 PRIMROSE LAKE CIR STE 103
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City | TAMPA
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State | FL
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Zip | 33647-3764
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Country | US
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Telephone | 727-386-9255
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Fax |
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Provider Business Mailing Address
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Address Line | 5233 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-0533
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Country | US
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Telephone | 813-708-9030
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW21883
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License Number State | FL
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