Provider Demographics
NPI:1881342830
Name:BOLER, NICHOLAS JERARD
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JERARD
Last Name:BOLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MCCALEP-MCINTOSH HALL- BHWTP2, GRADUATE OF S W
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762
Mailing Address - Country:US
Mailing Address - Phone:205-601-6657
Mailing Address - Fax:205-206-9777
Practice Address - Street 1:107 MCCALEP-MCINTOSH HALL- BHWTP2, GRADUATE OF S W
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762
Practice Address - Country:US
Practice Address - Phone:205-601-6657
Practice Address - Fax:205-206-9777
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker