Provider Demographics
NPI:1922250398
Name:BOESER, CARMEN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:C
Last Name:BOESER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:E
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:729 W CANTERBURY RD
Mailing Address - Street 2:APT C
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4522
Mailing Address - Country:US
Mailing Address - Phone:314-809-8559
Mailing Address - Fax:
Practice Address - Street 1:729 W CANTERBURY RD
Practice Address - Street 2:APT C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-4522
Practice Address - Country:US
Practice Address - Phone:314-809-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical