Provider Demographics
NPI:1164724720
Name:BOLSON, ELISABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:
Last Name:BOLSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 WANAMAKER AVE
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1932
Mailing Address - Country:US
Mailing Address - Phone:201-967-2499
Mailing Address - Fax:
Practice Address - Street 1:86 WANAMAKER AVE
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1932
Practice Address - Country:US
Practice Address - Phone:201-967-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC0075651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical