Provider Demographics
NPI:1790031631
Name:BOLTON, JAMIE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MARIE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HOUSE AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2308
Mailing Address - Country:US
Mailing Address - Phone:717-745-6166
Mailing Address - Fax:
Practice Address - Street 1:207 HOUSE AVE STE 109
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2308
Practice Address - Country:US
Practice Address - Phone:717-745-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017227103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist