Provider Demographics
NPI:1467291591
Name:BOYD, JESSE RAY
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:RAY
Last Name:BOYD
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 1:175 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-1847
Mailing Address - Country:US
Mailing Address - Phone:541-561-7260
Mailing Address - Fax:
Practice Address - Street 1:175 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-1847
Practice Address - Country:US
Practice Address - Phone:541-561-7260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)