Provider Demographics
NPI:1962825687
Name:BOYD, JERALYN (MA, LISW)
Entity Type:Individual
Prefix:MRS
First Name:JERALYN
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:MA, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 COTTONWOOD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5930
Mailing Address - Country:US
Mailing Address - Phone:513-499-1765
Mailing Address - Fax:
Practice Address - Street 1:7162 READING RD STE 500
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3899
Practice Address - Country:US
Practice Address - Phone:513-761-6222
Practice Address - Fax:513-679-4590
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 17001011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0205946Medicaid