Provider Demographics
NPI:1467798744
Name:BOLDUC, JOSEPH (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:BOLDUC
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52R POINT ST
Mailing Address - Street 2:
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1915
Mailing Address - Country:US
Mailing Address - Phone:203-962-1710
Mailing Address - Fax:
Practice Address - Street 1:5959 COLLINS AVE
Practice Address - Street 2:APT. 1403
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2289
Practice Address - Country:US
Practice Address - Phone:305-209-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11465101YM0800X
NY005803-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health