Provider Demographics
NPI:1275113888
Name:BOLEK, CLARE SAVAGE
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:SAVAGE
Last Name:BOLEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RANDOLPH RD # 304
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1209
Mailing Address - Country:US
Mailing Address - Phone:301-807-7235
Mailing Address - Fax:
Practice Address - Street 1:12504 ARBOR VIEW TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1412
Practice Address - Country:US
Practice Address - Phone:301-807-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD169191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical