Provider Demographics
NPI:1982965018
Name:BOLEBRUCH, CHERYL MARIE (PHD)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:MARIE
Last Name:BOLEBRUCH
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 1:6 KENMORE RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1022
Mailing Address - Country:US
Mailing Address - Phone:516-437-7645
Mailing Address - Fax:516-616-6065
Practice Address - Street 1:6 KENMORE RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1022
Practice Address - Country:US
Practice Address - Phone:516-437-7645
Practice Address - Fax:516-616-6065
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist