Provider Demographics
NPI:1518232883
Name:BOLEY-JACKSON, VICTORIA J (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:J
Last Name:BOLEY-JACKSON
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HUNTING RD
Mailing Address - Street 2:
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3928
Mailing Address - Country:US
Mailing Address - Phone:518-452-7780
Mailing Address - Fax:
Practice Address - Street 1:400 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2920
Practice Address - Country:US
Practice Address - Phone:518-475-6850
Practice Address - Fax:518-476-6852
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0620101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical