MEDICARE: EVAN VANDY BOLLINGER M.ED., LMHC

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	101YM0800X	Mental Health Counselor	5278	MA
2	1041C0700X	Clinical Social Worker	203113	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LM1086	OTHER	MA	BCBSMA PROVIDER NUMBER
2	5278	OTHER	MA	LMHC LICENSE NUMBER

General Provider Information

NPI Number	:	1851424055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN VANDY BOLLINGER M.ED., LMHC

Provider Business Mailing Address
First Line	:	53 JUGGLER MEADOW RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9521
Country	:	US
Telephone Number	:	413-548-3970
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 JUGGLER MEADOW RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9521
Country	:	US
Telephone Number	:	413-548-3970
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	09/11/2025

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