Provider Demographics
NPI:1033386768
Name:EERKENS, BOUKJE ELISABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BOUKJE
Middle Name:ELISABETH
Last Name:EERKENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NORTHGATE DR STE 12
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2544
Mailing Address - Country:US
Mailing Address - Phone:415-272-3406
Mailing Address - Fax:
Practice Address - Street 1:1050 NORTHGATE DR STE 12
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2544
Practice Address - Country:US
Practice Address - Phone:415-272-3406
Practice Address - Fax:415-300-3086
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2021-01-04
Deactivation Date:2017-05-17
Deactivation Code:
Reactivation Date:2018-03-08
Provider Licenses
StateLicense IDTaxonomies
CAPSY20001103T00000X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic