Provider Demographics
NPI:1679009328
Name:BOLEY, MWALIMU STEVE (LBSC)
Entity Type:Individual
Prefix:
First Name:MWALIMU
Middle Name:STEVE
Last Name:BOLEY
Suffix:
Gender:M
Credentials:LBSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6866 RADBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-5214
Mailing Address - Country:US
Mailing Address - Phone:267-401-5243
Mailing Address - Fax:
Practice Address - Street 1:6866 RADBOURNE RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5214
Practice Address - Country:US
Practice Address - Phone:267-401-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002119103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst