Provider Demographics
NPI:1437732831
Name:BOXER, MIA (LSW)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:BOXER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CEDAR AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2165
Mailing Address - Country:US
Mailing Address - Phone:973-954-6120
Mailing Address - Fax:
Practice Address - Street 1:425 CEDAR AVE APT 2
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2165
Practice Address - Country:US
Practice Address - Phone:973-954-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL066244001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical