Provider Demographics
NPI:1598815029
Name:BOES, CAROLE M (LCSW, CEAP)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:M
Last Name:BOES
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022-A N. MAIN ST.
Mailing Address - Street 2:2ND FLOOR, AVADA BUILDING
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-0524
Mailing Address - Country:US
Mailing Address - Phone:412-629-0320
Mailing Address - Fax:724-282-9728
Practice Address - Street 1:1022-A N. MAIN ST.
Practice Address - Street 2:2ND FLOOR, AVADA BUILDING
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-0524
Practice Address - Country:US
Practice Address - Phone:412-629-0320
Practice Address - Fax:724-282-9728
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW002686L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA715337OtherMAGELLAN
PA11630780OtherCAQH UNIVERSAL CREDENTIAL
PA742115OtherAETNA