Provider Demographics
NPI:1710177266
Name:BOLDUC, ROBYN ANN (MS)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:ANN
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4371
Mailing Address - Country:US
Mailing Address - Phone:301-696-5596
Mailing Address - Fax:301-695-9694
Practice Address - Street 1:65 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4371
Practice Address - Country:US
Practice Address - Phone:301-696-5596
Practice Address - Fax:301-695-9694
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional