Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0512 | NH |
Y | 1041C0700X | Clinical Social Worker | 1021 | NH |
NPI | 1265825608 |
---|---|
Provider Name | Mr. Martin Paul Boldin JR. |
First Address | Hampton, NH 03842-2389 |
Second Address | Hampton, NH 03842-2389 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2015 |
Last Update Date | 10/03/2015 |