Provider Demographics
NPI:1346385853
Name:BOYER, JERRY EDWIN (MA)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:EDWIN
Last Name:BOYER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-3111
Mailing Address - Country:US
Mailing Address - Phone:717-248-1174
Mailing Address - Fax:717-248-1175
Practice Address - Street 1:47 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2202
Practice Address - Country:US
Practice Address - Phone:717-248-1174
Practice Address - Fax:717-248-1175
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002678L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA338947OtherVALUE OPTIONS
PA03106101OtherCBC PRACTITIONER ID
PA338947OtherVALUE OPTIONS