Provider Demographics
NPI:1659858504
Name:BOYER, JUDY GAYE (LMSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:GAYE
Last Name:BOYER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 EDEN GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9605
Mailing Address - Country:US
Mailing Address - Phone:248-515-7024
Mailing Address - Fax:
Practice Address - Street 1:1418 EDEN GARDENS DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-9605
Practice Address - Country:US
Practice Address - Phone:248-515-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010650041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical