Provider Demographics
NPI:1679031496
Name:BOERS, JUDY LORAINE (LEP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LORAINE
Last Name:BOERS
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-2215
Mailing Address - Country:US
Mailing Address - Phone:916-296-4211
Mailing Address - Fax:
Practice Address - Street 1:60 50TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2215
Practice Address - Country:US
Practice Address - Phone:916-296-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2412103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool