Debra Boltas, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

001924 Issued in CT

Practice address

66 Trumbull St
New Haven, CT 06510-1012

Phone

(203) 787-9119

NPI assigned

Feb 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 2, 2016 through Nov 2, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104952381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "198 LAWRENCE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065112417",
            "telephone_number": "203-824-4476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 TRUMBULL ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065101012",
            "telephone_number": "203-787-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTAS",
        "first_name": "DEBRA",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krysten Bold, PHD
• Yajaira Bolden, DENTAL HYGIENIST
• Ana Beatriz Bolio Ruiz, M.D.
• Amita Rao Bollapragada
• Jean L Bolognia, MD
• Ty B. Bolte, MD
• Yvonne Bolumole, APRN, RN
• Bondage Breakers Counseling, LLC
• Pramod Bonde, MD
• Kathryn Bonese, M.D.

• Clinical Psychologist in New Haven, CT
• Providers in New Haven, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.