Active NPI
Jeanne M. Bolton, PH.D.
- Clinical Psychologist
- Columbia, MD
National Provider Identifier
1760601181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1855
- Practice address
- 7270 Cradlerock Way
Columbia, MD 21045-5025 - Phone
- (410) 290-6618
- Fax
- (410) 290-6618
- NPI assigned
- Apr 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 1855 | MD | |
| Clinical Psychologist | 103TC0700X | 1855 | MD | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1855 | MD |
Addresses
Primary practice location
7270 Cradlerock Way
Columbia, MD 21045-5025
Mailing address
7270 Cradlerock Way
Columbia, MD 21045-5092
Phone (410) 290-6618
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 235733 | Other | MD | MDIPA PROVIDER # |
| 20-17562656 | Other | MD | EIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1855 | MD | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287964800000",
"number": "1760601181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7270 CRADLEROCK WAY",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210455092",
"telephone_number": "410-290-6618",
"fax_number": "410-290-6618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7270 CRADLEROCK WAY",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210455025",
"telephone_number": "410-290-6618",
"fax_number": "410-290-6618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLTON",
"first_name": "JEANNE",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-24",
"last_updated": "2010-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MD",
"license": "1855",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "1855",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MD",
"license": "1855",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MDIPA PROVIDER #",
"identifier": "235733",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EIN",
"identifier": "20-17562656",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.