Provider Demographics
NPI:1699819565
Name:BOLTON, DANIEL D (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:D
Last Name:BOLTON
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BROOKLINE ST APT 105
Mailing Address - Street 2:CAMBRIDGE
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4198
Mailing Address - Country:US
Mailing Address - Phone:617-407-1380
Mailing Address - Fax:
Practice Address - Street 1:1151 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5201
Practice Address - Country:US
Practice Address - Phone:617-407-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health