Provider Demographics
NPI:1225450935
Name:BOYSEN, PAMELA (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BOYSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 SEAL BEACH BLVD
Mailing Address - Street 2:STE 360
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2747
Mailing Address - Country:US
Mailing Address - Phone:714-844-7282
Mailing Address - Fax:913-349-9075
Practice Address - Street 1:13001 SEAL BEACH BLVD
Practice Address - Street 2:STE 360
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2747
Practice Address - Country:US
Practice Address - Phone:714-844-7282
Practice Address - Fax:913-349-9075
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013045152104100000X
CA941601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker