Provider Demographics
NPI:1437238730
Name:BOLDUC, WILLIAM EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:BOLDUC
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 COMMON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6678
Mailing Address - Country:US
Mailing Address - Phone:207-877-9222
Mailing Address - Fax:207-872-5888
Practice Address - Street 1:18 COMMON ST STE 3
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6678
Practice Address - Country:US
Practice Address - Phone:207-877-9222
Practice Address - Fax:207-872-5888
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC81251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELC8125OtherLCSW LICENSE
ME267730099Medicaid