Provider Demographics
NPI:1174853055
Name:BOYLE, PATRICK EDWARD
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:EDWARD
Last Name:BOYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 LEE BLVD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1268
Mailing Address - Country:US
Mailing Address - Phone:216-287-6691
Mailing Address - Fax:216-398-6350
Practice Address - Street 1:2490 LEE BLVD
Practice Address - Street 2:SUITE 314
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1268
Practice Address - Country:US
Practice Address - Phone:216-287-6691
Practice Address - Fax:216-398-6350
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0004916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker