MEDICARE: DR. DAVID BOLTSON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY4458	FL

General Provider Information

NPI Number	:	1275676637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BOLTSON PSY.D.

Provider Business Mailing Address
First Line	:	6300 HATTERAS CLUB DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6539
Country	:	US
Telephone Number	:	561-718-9590
Fax Number	:	561-570-5999

Provider Business Practice Location Address
First Line	:	1375 GATEWAY BLVD STE 31
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8304
Country	:	US
Telephone Number	:	561-649-3309
Fax Number	:	561-570-5999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	06/06/2024

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