Provider Demographics
NPI:1003916602
Name:BOYKIN, FRED F (MSW)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:F
Last Name:BOYKIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LAS OLAS WAY APT 2304
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2388
Mailing Address - Country:US
Mailing Address - Phone:301-404-3602
Mailing Address - Fax:
Practice Address - Street 1:2312 WILTON DR
Practice Address - Street 2:STE 29
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1249
Practice Address - Country:US
Practice Address - Phone:301-404-3602
Practice Address - Fax:301-576-3538
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW140841041C0700X
DCLC3022551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC738695C27Medicare ID - Type Unspecified