Provider Demographics
NPI:1922279975
Name:BOSTON, MARTHA B (PHD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:B
Last Name:BOSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 EDGMONT AVE
Mailing Address - Street 2:SUITE 2575
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3962
Mailing Address - Country:US
Mailing Address - Phone:302-547-4956
Mailing Address - Fax:
Practice Address - Street 1:1350 EDGMONT AVE
Practice Address - Street 2:SUITE 2575
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3962
Practice Address - Country:US
Practice Address - Phone:302-547-4956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005955L103TA0400X
DEB1-0000370103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)