Provider Demographics
NPI:1598188583
Name:BOLTON, AMY MAE
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MAE
Last Name:BOLTON
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 1:344 WELLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1350
Mailing Address - Country:US
Mailing Address - Phone:339-222-1549
Mailing Address - Fax:978-256-0667
Practice Address - Street 1:21 GLEN AVE
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2858
Practice Address - Country:US
Practice Address - Phone:978-256-0667
Practice Address - Fax:978-256-5567
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist