Provider Demographics
NPI:1629516406
Name:BOLTZ-MCCARTHY, SUSAN ANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNE
Last Name:BOLTZ-MCCARTHY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2827
Mailing Address - Country:US
Mailing Address - Phone:603-762-4429
Mailing Address - Fax:
Practice Address - Street 1:38 PARK PL
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2827
Practice Address - Country:US
Practice Address - Phone:603-762-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT642101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor