Provider Demographics
NPI:1073284071
Name:BOYNTON, SHEILA DIANE (LSW)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DIANE
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 ERRINGER PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4118
Mailing Address - Country:US
Mailing Address - Phone:267-253-2287
Mailing Address - Fax:
Practice Address - Street 1:5020 ERRINGER PL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4118
Practice Address - Country:US
Practice Address - Phone:267-253-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128672101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor