Provider Demographics
NPI:1497143606
Name:BOYKIN, VIRGINIA (MS LBSC)
Entity Type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:MS LBSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 S 57TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2702
Mailing Address - Country:US
Mailing Address - Phone:610-659-1491
Mailing Address - Fax:
Practice Address - Street 1:824 S 57TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2702
Practice Address - Country:US
Practice Address - Phone:610-659-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000271103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0Medicaid