Provider Demographics
NPI:1679801278
Name:BOSTON, DOROTHY L (PSYD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:BOSTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:15167 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25515-6615
Practice Address - Country:US
Practice Address - Phone:304-675-5725
Practice Address - Fax:304-675-5727
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6843103TC0700X
WV749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical