Individual
MARY BETH BOULDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LPC
Contact information
Practice address
5501 OLD YORK RD, MOSS 1, OFFICE 139, PHILADELPHIA, PA 19141-3018
(215) 456-9884
Mailing address
3015 DARBY RD, ARDMORE, PA 19003-1623
(610) 449-1969
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
PC000160
PA
104100000X
Social Worker
Primary
SW124663
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CW015559
LCSW
PA
01
—
PC000160
PROFESSIONAL COUNSELOR
PA
Enumeration date
04/07/2006
Last updated
10/03/2007
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