Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY 7398 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 7398 | FL |
NPI | 1003992181 |
---|---|
Provider Name | Dr. Jonina Daum Bolton |
First Address | Sunrise, FL 33351-6249 |
Second Address | Sunrise, FL 33351-6249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |