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General NPI Number Information
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NPI Number | 1801501119
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Entity Type | Organization
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Legal Business Name | BOULOS PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 60 EDGEWOOD RD
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City | CAPE ELIZABETH
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State | ME
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Zip | 04107-1277
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Country | US
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Telephone | 207-671-7361
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Fax |
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Provider Business Mailing Address
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Address Line | 60 EDGEWOOD RD
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City | CAPE ELIZABETH
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State | ME
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Zip | 04107-1277
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Country | US
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Telephone | 207-671-7361
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | JAYNE BOULOS
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Credential | PSYD
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Telephone | 207-671-7361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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