Provider Demographics
NPI:1447432513
Name:KUO-BOYER, MABLE SHYH-WEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MABLE
Middle Name:SHYH-WEN
Last Name:KUO-BOYER
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 1:2028 W ORANGEBURG AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3742
Mailing Address - Country:US
Mailing Address - Phone:209-577-3899
Mailing Address - Fax:
Practice Address - Street 1:2028 W ORANGEBURG AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3742
Practice Address - Country:US
Practice Address - Phone:209-577-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS19696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22015ZMedicare PIN