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MS. SUSAN MARIE BOLLES LCSW
NPI 1043363609
Counselor - Mental Health in Brooklyn, NY

Active since January 18, 2007Opted out of Medicare · through Jan 1, 2028
909 UNION ST, BROOKLYN, NY 11215(718) 859-6606(718) 859-6606 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ms. Susan Marie Bolles Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. SUSAN MARIE BOLLES LCSW (NPI 1043363609) is an individual mental health provider in Brooklyn, New York, licensed in New York (RO54403) and active in the NPI registry since January 2007. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1043363609
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameMS. SUSAN MARIE BOLLESCredential: LCSW
Location Address909 UNION STBrooklyn, NY 11215-1465
Mailing Address776 Westminster RdBrooklyn, NY 11230-2402 · (718) 859-6606 · Fax (718) 859-6606
Phone(718) 859-6606
Fax(718) 859-6606
Sole ProprietorYes
Enumeration DateJanuary 18, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1043363609 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in NY · RO54403
909 UNION ST, Brooklyn, NY 11215
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Ms. Susan Marie Bolles Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2022 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2022
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susan Bolles's NPI number?

The NPI number for Susan Bolles is 1043363609. It was assigned to this individual provider in the NPPES registry on January 18, 2007.

Where is Susan Bolles located?

Susan Bolles practices at 909 Union St, Brooklyn, NY 11215. The listed phone number is (718) 859-6606.

What is Susan Bolles's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Susan Bolles enrolled in Medicare?

No. Susan Bolles has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Susan Bolles was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.