Provider Demographics
NPI:1639437544
Name:BOISVERT, JENNIFER ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
Last Name:BOISVERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 W OCEAN BLVD
Mailing Address - Street 2:STE 18
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4605
Mailing Address - Country:US
Mailing Address - Phone:714-898-0362
Mailing Address - Fax:714-893-3269
Practice Address - Street 1:110 W OCEAN BLVD
Practice Address - Street 2:STE 18
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4605
Practice Address - Country:US
Practice Address - Phone:714-898-0362
Practice Address - Fax:714-893-3269
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21459103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical