Provider Demographics
NPI:1508012113
Name:BOILEAU, SEAN NICHOLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:NICHOLAS
Last Name:BOILEAU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2319
Mailing Address - Country:US
Mailing Address - Phone:213-201-1337
Mailing Address - Fax:213-201-1337
Practice Address - Street 1:611 S KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2319
Practice Address - Country:US
Practice Address - Phone:213-201-1337
Practice Address - Fax:213-201-1337
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24035103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling