Provider Demographics
NPI:1467838029
Name:BOLSTAD, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BOLSTAD
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 1:81 BLUEBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2304
Mailing Address - Country:US
Mailing Address - Phone:617-650-6497
Mailing Address - Fax:
Practice Address - Street 1:81 BLUEBERRY HILL RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2304
Practice Address - Country:US
Practice Address - Phone:617-650-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health