Provider Demographics
NPI:1245841881
Name:BOYIAKIS, ELLEN (LCAT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BOYIAKIS
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLONY LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2013
Mailing Address - Country:US
Mailing Address - Phone:917-923-3750
Mailing Address - Fax:
Practice Address - Street 1:28 E OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4292
Practice Address - Country:US
Practice Address - Phone:631-438-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001323-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83-4233164OtherTAX ID