Provider Demographics
NPI:1639429624
Name:BOULARD, NINA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:E
Last Name:BOULARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-4037
Mailing Address - Fax:207-973-5845
Practice Address - Street 1:905 UNION ST
Practice Address - Street 2:STE 9
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3050
Practice Address - Country:US
Practice Address - Phone:207-973-4037
Practice Address - Fax:207-973-5845
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1146103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth