Provider Demographics
NPI:1285298091
Name:BOLDIN, PAULINE (LCSW-C)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:BOLDIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 PROFESSIONAL PL STE 200
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2229
Mailing Address - Country:US
Mailing Address - Phone:301-577-4470
Mailing Address - Fax:
Practice Address - Street 1:8100 PROFESSIONAL PL STE 200
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2229
Practice Address - Country:US
Practice Address - Phone:301-577-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC103861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical