Provider Demographics
NPI:1083924914
Name:BOLAND, DANIEL J (LADC1)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:BOLAND
Suffix:
Gender:M
Credentials:LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:EAST HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-1307
Mailing Address - Country:US
Mailing Address - Phone:508-237-1584
Mailing Address - Fax:
Practice Address - Street 1:36 PARTRIDGE LN
Practice Address - Street 2:
Practice Address - City:EAST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1307
Practice Address - Country:US
Practice Address - Phone:508-237-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1944101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)