Provider Demographics
NPI:1679886931
Name:BOELKE, JOANNE GALATEA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:GALATEA
Last Name:BOELKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:SOUTH EGREMONT
Mailing Address - State:MA
Mailing Address - Zip Code:01258-0010
Mailing Address - Country:US
Mailing Address - Phone:518-965-4207
Mailing Address - Fax:413-528-5274
Practice Address - Street 1:58 CREAMERY RD.
Practice Address - Street 2:JOANNE BOELKE
Practice Address - City:SOUTH EGREMONT
Practice Address - State:MA
Practice Address - Zip Code:01258
Practice Address - Country:US
Practice Address - Phone:518-965-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001130731041C0700X
NY0582511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY056251OtherLCSW