Individual
DR. BARBARA BRADLEY BOLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
17 CONKLIN ST, 2ND FLOOR, FARMINGDALE, NY 11735-2557
(516) 454-6921
Mailing address
331 SCUDDER AVE, NORTHPORT, NY 11768-3020
(516) 454-6921
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
009514-0
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01249889
—
NY
Enumeration date
09/23/2006
Last updated
07/08/2007
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