Provider Demographics
NPI:1346661113
Name:DANIEL BOLTON, LMHC LLC
Entity Type:Organization
Organization Name:DANIEL BOLTON, LMHC LLC
Other - Org Name:CAMBRIDGE CHILD AND FAMILY COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-407-1380
Mailing Address - Street 1:61 ROSELAND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3524
Mailing Address - Country:US
Mailing Address - Phone:617-407-1380
Mailing Address - Fax:617-661-5679
Practice Address - Street 1:61 ROSELAND ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3524
Practice Address - Country:US
Practice Address - Phone:617-407-1380
Practice Address - Fax:617-661-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-22
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty