Provider Demographics
NPI:1003242793
Name:BOLAND, JONATHAN R (LCSW, BCD, MPH)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:R
Last Name:BOLAND
Suffix:
Gender:M
Credentials:LCSW, BCD, MPH
Other - Prefix:
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Mailing Address - Street 1:NAVAL CONSOLIDATED BRIG MIRAMAR
Mailing Address - Street 2:46141 MIRAMAR WAY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126
Mailing Address - Country:US
Mailing Address - Phone:858-307-7184
Mailing Address - Fax:
Practice Address - Street 1:2514 E 6TH ST APT A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-7363
Practice Address - Country:US
Practice Address - Phone:858-295-3841
Practice Address - Fax:858-216-8057
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA757871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical