Provider Demographics
NPI:1528513256
Name:BOLING, JAYME FAYE (LMSW)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:FAYE
Last Name:BOLING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-2170
Mailing Address - Country:US
Mailing Address - Phone:860-774-2020
Mailing Address - Fax:860-774-0826
Practice Address - Street 1:1007 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-2170
Practice Address - Country:US
Practice Address - Phone:860-774-2020
Practice Address - Fax:860-774-0826
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003468104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid