Provider Demographics
NPI:1235420613
Name:BOYD, NOELLE MELINDA (MSW)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:MELINDA
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 28TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3614
Mailing Address - Country:US
Mailing Address - Phone:801-616-0781
Mailing Address - Fax:
Practice Address - Street 1:101 JOSE FIGUERES AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2022
Practice Address - Country:US
Practice Address - Phone:408-347-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24569104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker