Provider Demographics
NPI:1558470757
Name:BOYLE, ROBERT JON
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JON
Last Name:BOYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20751 DUMONT ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3402
Mailing Address - Country:US
Mailing Address - Phone:818-346-5186
Mailing Address - Fax:818-883-9752
Practice Address - Street 1:4869 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4255
Practice Address - Country:US
Practice Address - Phone:818-346-5186
Practice Address - Fax:818-883-9752
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS118251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW11B25Medicare ID - Type Unspecified
R37072Medicare UPIN