Provider Demographics
NPI:1548337108
Name:KING-BOLGER, ANNE MARY (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARY
Last Name:KING-BOLGER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:KING-BOLGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4 GREAT MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1490
Mailing Address - Country:US
Mailing Address - Phone:508-429-7682
Mailing Address - Fax:
Practice Address - Street 1:88 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6354
Practice Address - Country:US
Practice Address - Phone:508-620-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1048861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAKIPO5919Medicare ID - Type Unspecified