Provider Demographics
NPI:1881835395
Name:BOAN, WILLIAM F (LMFT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:BOAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N COUNTY LINE RD
Mailing Address - Street 2:BLDG 3 SUITE 6
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1255
Mailing Address - Country:US
Mailing Address - Phone:732-664-0772
Mailing Address - Fax:732-928-6290
Practice Address - Street 1:19 N COUNTY LINE RD
Practice Address - Street 2:BLDG 3 SUITE 6
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1255
Practice Address - Country:US
Practice Address - Phone:732-664-0772
Practice Address - Fax:732-928-6290
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100166800106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020567Medicare PIN