Provider Demographics
NPI:1871218156
Name:BOULAS, DAWN
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BOULAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HOPKINS CT
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3053
Mailing Address - Country:US
Mailing Address - Phone:203-415-1530
Mailing Address - Fax:
Practice Address - Street 1:4 HOPKINS CT
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3053
Practice Address - Country:US
Practice Address - Phone:203-415-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27-002977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist