Emanuel T Vanbolden, PHD LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301013909 Issued in MI

Practice address

42335 Woodward Ave
Bloomfield Hills, MI 48304-5040

Phone

(248) 333-1083

NPI assigned

Jul 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1952500621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42335 WOODWARD AVE",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483045040",
            "telephone_number": "248-333-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42335 WOODWARD AVE",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483045040",
            "telephone_number": "248-333-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANBOLDEN",
        "first_name": "EMANUEL",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "PHD LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-13",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301011393",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301013909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Ann Valentine
• Firoza B Van Horn, PSY. D.
• Carol Van Kampen, LMSW
• Pamela Sue Van Kampen, M.ED, LPC
• Sara Lynn Van Wormer, MA, LLP
• Katherine Aileen Vance, LMSW
• Agnes E Vandeputte, CRNA
• Victoria Lyn Vander Velde, PA
• George Lawrence Vanderbossche, MA, LLP
• Lori Vansloten

• Clinical Psychologist in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.