Provider Demographics
NPI:1063824258
Name:BOLTON, NOEMI AURELIO
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:AURELIO
Last Name:BOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOEMI
Other - Middle Name:AURELIO
Other - Last Name:BOLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:24 MINE ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-6500
Mailing Address - Country:US
Mailing Address - Phone:908-246-7489
Mailing Address - Fax:908-806-2379
Practice Address - Street 1:24 MINE ST STE 2D
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-6500
Practice Address - Country:US
Practice Address - Phone:908-246-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055505001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical