Provider Demographics
NPI:1023220845
Name:BOLDUC, MARC GILBERT (LICSW, CADC II, CGP)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:GILBERT
Last Name:BOLDUC
Suffix:
Gender:M
Credentials:LICSW, CADC II, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-726-6185
Mailing Address - Fax:
Practice Address - Street 1:100 BLOSSOM STREET
Practice Address - Street 2:COX BUILDING, FIRST FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2606
Practice Address - Country:US
Practice Address - Phone:617-726-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical