Provider Demographics
NPI:1083981435
Name:BOLES, RACHEL (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BOLES
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 GILCREAST RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3564
Mailing Address - Country:US
Mailing Address - Phone:603-552-5116
Mailing Address - Fax:
Practice Address - Street 1:75 GILCREAST ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-2938
Practice Address - Country:US
Practice Address - Phone:603-552-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH12324242OtherAETNA