Provider Demographics
NPI:1831855956
Name:BOLGER, MARY E (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BOLGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ARCH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6512
Mailing Address - Country:US
Mailing Address - Phone:203-625-8309
Mailing Address - Fax:
Practice Address - Street 1:37 ARCH ST FL 1
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6512
Practice Address - Country:US
Practice Address - Phone:203-625-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002163103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist