Provider Demographics
NPI:1851629091
Name:BOYLAN-MENDES, AMY MARIE
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:BOYLAN-MENDES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:BOYLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 MODESTO AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0414
Mailing Address - Country:US
Mailing Address - Phone:209-527-4597
Mailing Address - Fax:209-527-4599
Practice Address - Street 1:103 MODESTO AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0414
Practice Address - Country:US
Practice Address - Phone:209-527-4597
Practice Address - Fax:209-527-4599
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)