Provider Demographics
NPI:1497540918
Name:ELAINE BOLAND PHD LLC
Entity type:Organization
Organization Name:ELAINE BOLAND PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-200-0183
Mailing Address - Street 1:868 HADDON AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1943
Mailing Address - Country:US
Mailing Address - Phone:609-200-0183
Mailing Address - Fax:
Practice Address - Street 1:414 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2542
Practice Address - Country:US
Practice Address - Phone:609-200-0183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty