Provider Demographics
NPI:1942411228
Name:BOREN, STEPHEN IRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:IRA
Last Name:BOREN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 SPROUL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3510
Mailing Address - Country:US
Mailing Address - Phone:610-626-8085
Mailing Address - Fax:610-626-8032
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:APT. D301
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:301-802-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist