Provider Demographics
NPI:1790353993
Name:BOATWRIGHT, BRET (PSYD, LLP)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:
Last Name:BOATWRIGHT
Suffix:
Gender:M
Credentials:PSYD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 DRAKE AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1751
Mailing Address - Country:US
Mailing Address - Phone:914-309-7058
Mailing Address - Fax:
Practice Address - Street 1:183 DRAKE AVE APT 1A
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-1751
Practice Address - Country:US
Practice Address - Phone:914-309-7058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP127031103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist