Provider Demographics
NPI:1093889487
Name:BOYLE, JUDITH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:MALONEY
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:46 GREENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3820
Mailing Address - Country:US
Mailing Address - Phone:781-259-8977
Mailing Address - Fax:781-259-8977
Practice Address - Street 1:46 GREENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-3820
Practice Address - Country:US
Practice Address - Phone:781-259-8977
Practice Address - Fax:781-259-8977
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN03426106OtherUNITED BEHAV HEALTH
MA70010000PO8221OtherBLUE CROSS BLUE SHIELD
MA1853945Medicaid
MA1853945Medicaid