Provider Demographics
NPI:1568193969
Name:BOARDMAN, MARY (MSS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2801
Mailing Address - Country:US
Mailing Address - Phone:267-858-7732
Mailing Address - Fax:
Practice Address - Street 1:345 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2801
Practice Address - Country:US
Practice Address - Phone:267-858-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker