Provider Demographics
NPI:1790728194
Name:BOYD, BERTINA HANSEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:BERTINA
Middle Name:HANSEN
Last Name:BOYD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 W WARD RD
Mailing Address - Street 2:200
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3024
Mailing Address - Country:US
Mailing Address - Phone:410-286-0664
Mailing Address - Fax:410-286-2834
Practice Address - Street 1:3175 W WARD RD
Practice Address - Street 2:200
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3024
Practice Address - Country:US
Practice Address - Phone:410-286-0664
Practice Address - Fax:410-286-2834
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD091901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403192000Medicaid
MD377MF596Medicare PIN