Provider Demographics
NPI:1760523971
Name:BOLAND, THOMAS B (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:BOLAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E 40TH ST
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1731
Mailing Address - Country:US
Mailing Address - Phone:212-687-0789
Mailing Address - Fax:212-687-5976
Practice Address - Street 1:140 E 40TH ST
Practice Address - Street 2:SUITE 1 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1731
Practice Address - Country:US
Practice Address - Phone:212-687-0789
Practice Address - Fax:212-687-5976
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4631103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent