Provider Demographics
NPI:1366588436
Name:BOLTON, RENDELLE ELAINE
Entity type:Individual
Prefix:MS
First Name:RENDELLE
Middle Name:ELAINE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WHITE PL
Mailing Address - Street 2:APARTMENT #2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7614
Mailing Address - Country:US
Mailing Address - Phone:617-566-6137
Mailing Address - Fax:
Practice Address - Street 1:338 MAIN ST STE 304
Practice Address - Street 2:RIVERSIDE COMMUNITY CARE OUTPATIENT CENTER AT WAKEFIELD
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5013
Practice Address - Country:US
Practice Address - Phone:781-246-2010
Practice Address - Fax:781-246-1448
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker