Provider Demographics
NPI:1659328052
Name:LABOY, NILDA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NILDA
Middle Name:M
Last Name:LABOY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NILDA
Other - Middle Name:M
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:ONE WELLS AVENUE
Mailing Address - Street 2:OFFICE 319
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:978-509-1047
Mailing Address - Fax:
Practice Address - Street 1:ONE WELLS AVE
Practice Address - Street 2:OFFICE 319
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:978-509-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7654103TA0400X, 103TC0700X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALA W50959Medicare ID - Type Unspecified