Provider Demographics
NPI:1124210232
Name:BOLTON, ELISA ESTHERA (PHD)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:ESTHERA
Last Name:BOLTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NH
Mailing Address - Zip Code:03870-2128
Mailing Address - Country:US
Mailing Address - Phone:603-430-2884
Mailing Address - Fax:
Practice Address - Street 1:304 PIONEER RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NH
Practice Address - Zip Code:03870-2128
Practice Address - Country:US
Practice Address - Phone:603-430-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1091103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical