Provider Demographics
NPI:1386039600
Name:BOYD-BERKS, DAISY ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:ALEXANDRA
Last Name:BOYD-BERKS
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 1:140 MODENA AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2007
Mailing Address - Country:US
Mailing Address - Phone:614-425-5259
Mailing Address - Fax:
Practice Address - Street 1:10 ELMGROVE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4124
Practice Address - Country:US
Practice Address - Phone:614-425-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082993-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical