Provider Demographics
NPI:1831782051
Name:BOULAY, AMY-LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:AMY-LYNN
Middle Name:
Last Name:BOULAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COUNTRY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7901
Mailing Address - Country:US
Mailing Address - Phone:401-996-6521
Mailing Address - Fax:
Practice Address - Street 1:14 COUNTRY WAY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7901
Practice Address - Country:US
Practice Address - Phone:401-996-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW039231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical