Provider Demographics
NPI:1134734965
Name:BOLAND, LAUREL (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:
Last Name:BOLAND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1540
Mailing Address - Country:US
Mailing Address - Phone:508-418-6888
Mailing Address - Fax:
Practice Address - Street 1:139 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4032
Practice Address - Country:US
Practice Address - Phone:508-909-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical