Provider Demographics
NPI:1710189063
Name:BOARDMAN, MARY BELL (DMIN)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BELL
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 PETER RD
Mailing Address - Street 2:
Mailing Address - City:WILLSEYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13864-1121
Mailing Address - Country:US
Mailing Address - Phone:607-659-3909
Mailing Address - Fax:
Practice Address - Street 1:217 PETER RD
Practice Address - Street 2:
Practice Address - City:WILLSEYVILLE
Practice Address - State:NY
Practice Address - Zip Code:13864-1121
Practice Address - Country:US
Practice Address - Phone:607-659-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist