Provider Demographics
NPI:1871584961
Name:BOULAY, GUY M (CAGS)
Entity type:Individual
Prefix:MS
First Name:GUY
Middle Name:M
Last Name:BOULAY
Suffix:
Gender:M
Credentials:CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2122
Mailing Address - Country:US
Mailing Address - Phone:401-658-0420
Mailing Address - Fax:
Practice Address - Street 1:3353 MENDON RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-2122
Practice Address - Country:US
Practice Address - Phone:401-658-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI91103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical