Provider Demographics
NPI:1962990275
Name:BOLGER, BRETT WILLIAM (PSYD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:WILLIAM
Last Name:BOLGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 E MAIN ST STE 5209
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2484
Mailing Address - Country:US
Mailing Address - Phone:508-930-8606
Mailing Address - Fax:
Practice Address - Street 1:500 FRANKLIN VILLAGE DR STE 212
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-4017
Practice Address - Country:US
Practice Address - Phone:508-930-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1159103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist