Provider Demographics
NPI:1043424872
Name:BOYD, VIRGINIA L (MSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 VICTORIA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3258
Mailing Address - Country:US
Mailing Address - Phone:617-529-6213
Mailing Address - Fax:
Practice Address - Street 1:78 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7010
Practice Address - Country:US
Practice Address - Phone:617-529-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1056031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA105603OtherSOCIAL WORK LICENSE