Provider Demographics
NPI:1235393562
Name:PETTIGREW BOYLE, JUDY (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:PETTIGREW BOYLE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13482 CAMINITO CARMEL
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:72014
Mailing Address - Country:US
Mailing Address - Phone:858-755-7406
Mailing Address - Fax:858-755-7404
Practice Address - Street 1:1337 CAMINO DEL MAR
Practice Address - Street 2:SUITE B
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014
Practice Address - Country:US
Practice Address - Phone:858-755-7406
Practice Address - Fax:858-755-7404
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT16828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist