Individual
JEFFREY E BOLEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
21403 CHAGRIN BLVD, BEACHWOOD, OH 44122-5322
(216) 346-5673
Mailing address
21403 CHAGRIN BLVD, RM 212, BEACHWOOD, OH 44122-5322
(216) 346-5673
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3496
OH
103TR0400X
Rehabilitation Psychologist
3496
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2057116
—
OH
Enumeration date
10/11/2006
Last updated
09/17/2015
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