Provider Demographics
NPI:1205068079
Name:BOELZNER, MEGAN L (LICSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:BOELZNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 OLD WEST CENTRAL ST APT B5
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2940
Mailing Address - Country:US
Mailing Address - Phone:603-345-9442
Mailing Address - Fax:
Practice Address - Street 1:78 SOUTH ST # L1
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-2119
Practice Address - Country:US
Practice Address - Phone:603-345-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215821104100000X
MA1182231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker