Provider Demographics
NPI:1780187245
Name:BOYD, PAULINE MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:MAE
Last Name:BOYD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 S INTERSTATE 25
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-9731
Mailing Address - Country:US
Mailing Address - Phone:719-676-2101
Mailing Address - Fax:
Practice Address - Street 1:6175 S INTERSTATE 25
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-9731
Practice Address - Country:US
Practice Address - Phone:719-676-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099252011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical