Provider Demographics
NPI:1417100835
Name:DAVID BOLTSON, PSY,D., P.A.
Entity Type:Organization
Organization Name:DAVID BOLTSON, PSY,D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-649-3309
Mailing Address - Street 1:7410 W BOYNTON BEACH BLVD STE B4
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6158
Mailing Address - Country:US
Mailing Address - Phone:561-649-3309
Mailing Address - Fax:561-731-1440
Practice Address - Street 1:7410 W BOYNTON BEACH BLVD STE B4
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6158
Practice Address - Country:US
Practice Address - Phone:561-649-3309
Practice Address - Fax:561-731-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty