Mary Angela Boland, LCP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810003602 Issued in VA

Practice address

1657 Merrimac TRL
Williamsburg, VA 23185-5624

Phone

(757) 220-3200

Fax

(757) 253-4371

NPI assigned

Apr 5, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Colonial Behavioral Health

  • Health Maintenance Organization
  • Williamsburg, VA
  • NPI 1841556776
  NPD (past)
• Middle Peninsula Northern Neck Mental Health & Retardation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gloucester, VA
  • NPI 1497717615
  NPD (past)

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1356303127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1657 MERRIMAC TRL",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231855624",
            "telephone_number": "757-220-3200",
            "fax_number": "757-253-4371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1657 MERRIMAC TRL",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231855624",
            "telephone_number": "757-220-3200",
            "fax_number": "757-253-4371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAND",
        "first_name": "MARY",
        "middle_name": "ANGELA",
        "credential": "LCP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810003602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "189775",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "O88011M",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189775",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "O88011M",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHKEEPERS",
            "identifier": "189775",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "294721",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloom Mental Health Foundation
• Victoria L Blouch, RBT
• Blue Harbor Counseling PLLC
• Kenneth Boecker, D.C.
• Jennifer Leight Bolam, COTA/L
• Stacy Kline Bolling, LPC
• Janis Bolton, LCSW
• David Thompson Bond, PSY.D
• Harley Bonniville, CPNP-PC
• Kevina R Boone, PMHNP

• Clinical Psychologist in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.