Provider Demographics
NPI:1124071063
Name:BOLDUC, COLLEEN ELAINE (MSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ELAINE
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:BOLDUC
Other - Last Name:DANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-0084
Mailing Address - Country:US
Mailing Address - Phone:207-647-0954
Mailing Address - Fax:207-647-0953
Practice Address - Street 1:41 DEPOT ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1212
Practice Address - Country:US
Practice Address - Phone:207-647-0954
Practice Address - Fax:207-647-0953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1339101YA0400X
ME4381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM6844Medicare ID - Type Unspecified