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General NPI Number Information
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NPI Number | 1477079374
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Entity Type | Individual
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Provider Name | ELAINE MEREDITH BOLAND PHD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 868 HADDON AVE STE 22
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City | COLLINGSWOOD
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State | NJ
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Zip | 08108-1943
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Country | US
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Telephone | 609-200-0183
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Fax |
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Provider Business Mailing Address
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Address Line | 414 WINDSOR DR
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City | CHERRY HILL
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State | NJ
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Zip | 08002-2542
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSO18260
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License Number State | PA
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