Provider Demographics
NPI:1063628717
Name:BOBOLA, DONALD T (PMHCNS - BC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:T
Last Name:BOBOLA
Suffix:
Gender:M
Credentials:PMHCNS - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2320
Mailing Address - Country:US
Mailing Address - Phone:508-679-0033
Mailing Address - Fax:508-679-0037
Practice Address - Street 1:170 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-2367
Practice Address - Country:US
Practice Address - Phone:401-396-9984
Practice Address - Fax:401-396-9945
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN208066364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult