1417218686 NPI number — MRS. BERNADETTE MARIE BOLAND MS.ED

Table of content: MRS. BERNADETTE MARIE BOLAND MS.ED (NPI 1417218686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417218686 NPI number — MRS. BERNADETTE MARIE BOLAND MS.ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLAND
Provider First Name:
BERNADETTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS.ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417218686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6167 WEST QUAKER ST
Provider Second Line Business Mailing Address:
THERAPEUTIC LINK FOR CHILDREN
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-662-4800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6167 WEST QUAKER ST
Provider Second Line Business Practice Location Address:
THERAPEUTIC LINK FOR CHILDREN
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-662-4800
Provider Business Practice Location Address Fax Number:
716-662-5700
Provider Enumeration Date:
06/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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