Provider Demographics
NPI:1558382655
Name:BOATMAN, JOY LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:LYNN
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 KALMIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5414
Mailing Address - Country:US
Mailing Address - Phone:619-282-7333
Mailing Address - Fax:619-282-7334
Practice Address - Street 1:2991 KALMIA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-5414
Practice Address - Country:US
Practice Address - Phone:619-282-7333
Practice Address - Fax:619-282-7334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY169580Medicaid
CA231497OtherMANAGED HEALTH NETWORK