Roseanne Marie Boldt, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

211 Robert Parker Coffin Rd
Long Grove, IL 60047

Phone

(847) 821-1459

Fax

(847) 359-7673

NPI assigned

Sep 26, 2006

Last updated

Jul 8, 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922109156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 ROBERT PARKER COFFIN RD",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "60047",
            "telephone_number": "847-821-1459",
            "fax_number": "847-359-7673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 ROBERT PARKER COFFIN RD",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "60047",
            "telephone_number": "847-821-1459",
            "fax_number": "847-359-7673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDT",
        "first_name": "ROSEANNE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0004907383",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Bala, MSN, APRN, FNP-BC
• Siddika Barkat, RDN, LDN, MSC
• Amir Berberkic, M.D.
• Monica Lisa Bieszczad, FNP-BC
• Lesli Susan Bitel-Koskela, R.D., L.D.N
• Lana Bratko, FNP-C
• Sara Buresh, OTR/L
• Lindley Caldwell, MS, OTR/L
• Mark L Cannon, DDS, MS
• Ashley Brooke Carson, LCSW

• Psychologist in Long Grove, IL
• Providers in Long Grove, IL by specialty
• Psychologist in Illinois

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.