Provider Demographics
NPI:1639653066
Name:BOULIN, GERMAINE (LMSW)
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:
Last Name:BOULIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2906
Mailing Address - Country:US
Mailing Address - Phone:718-940-2200
Mailing Address - Fax:718-940-2204
Practice Address - Street 1:3807 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2906
Practice Address - Country:US
Practice Address - Phone:718-940-2200
Practice Address - Fax:718-940-2204
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14265912OtherCAQH