Provider Demographics
NPI:1003677956
Name:BOUTON, TAYLOR OLIVIA (LMSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:OLIVIA
Last Name:BOUTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N GREENBUSH RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8581
Mailing Address - Country:US
Mailing Address - Phone:518-323-2826
Mailing Address - Fax:
Practice Address - Street 1:16 N GREENBUSH RD STE 205
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8581
Practice Address - Country:US
Practice Address - Phone:518-323-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health