Provider Demographics
NPI:1477524254
Name:BOBOLA, MARY (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BOBOLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-7888
Mailing Address - Fax:508-792-4392
Practice Address - Street 1:191 MAY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602
Practice Address - Country:US
Practice Address - Phone:508-368-7888
Practice Address - Fax:508-792-4392
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1026597104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
1061933OtherCIGNA HEALTH PLAN
33824OtherFALLON COMMUNITY HEALTH P
2043637OtherFIRST HEALTH
042472266OtherPRIVATE HEALTHCARE SYSTEM
580244000OtherMAGELLAN BEHAVIORAL HEALT
800011108OtherRAILROAD MEDICARE
P07209OtherBLUE SHIELD HMO BLUE
042472266OtherPACIFICARE
042472266OtherTHREE RIVERS
785946OtherMVP HEALTH CARE
P20253OtherMEDICARE B
P07209OtherBLUE SHIELD INDEMNITY
042472266OtherHEALTHCARE VALUE MANAGEME
P07209OtherBLUE CARE ELECT
04247226OtherONE HEALTH PLAN
042472266006OtherTRICARE CHAMPUS
042472266006OtherTRICARE CHAMPUS