Provider Demographics
NPI:1689972853
Name:BOARDMAN, NYSSA WITTLIFF (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NYSSA
Middle Name:WITTLIFF
Last Name:BOARDMAN
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 1:424 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1869
Mailing Address - Country:US
Mailing Address - Phone:617-435-5851
Mailing Address - Fax:
Practice Address - Street 1:93 UNION ST
Practice Address - Street 2:303 A
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2244
Practice Address - Country:US
Practice Address - Phone:617-435-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical