Provider Demographics
NPI:1295078004
Name:BOYKIN, RICHARD (MS PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BOYKIN
Suffix:
Gender:M
Credentials:MS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 W CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1934
Mailing Address - Country:US
Mailing Address - Phone:267-481-6899
Mailing Address - Fax:215-457-4803
Practice Address - Street 1:1443 W CAYUGA ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19140-1934
Practice Address - Country:US
Practice Address - Phone:267-481-6899
Practice Address - Fax:215-457-4803
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator