Provider Demographics
NPI:1013059831
Name:BOYER, BRET A (PHD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:A
Last Name:BOYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 LANSDOWNE AVENUE
Mailing Address - Street 2:SUITE 3008
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023
Mailing Address - Country:US
Mailing Address - Phone:610-524-1552
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:SUITE 3008
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-524-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005956L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023305OtherHIGHMARK
PA5657127OtherAETNA
PA0659085000OtherPERSONAL CHOICE
PA0014740920001Medicaid
PA0659085000OtherPERSONAL CHOICE