Provider Demographics
NPI:1023627627
Name:BOYER, PAUL JOHN
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:BOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8033 MACARTHUR BLVD UNIT 5031
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-7016
Mailing Address - Country:US
Mailing Address - Phone:415-289-9868
Mailing Address - Fax:
Practice Address - Street 1:2407 HAVENSCOURT BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-1932
Practice Address - Country:US
Practice Address - Phone:415-289-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1178131041C0700X
KS11755104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical