Provider Demographics
NPI:1740509082
Name:BOYKINS, TABATHA SHERE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TABATHA
Middle Name:SHERE
Last Name:BOYKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 101ST AVE
Mailing Address - Street 2:1FL.
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1409
Mailing Address - Country:US
Mailing Address - Phone:917-756-6196
Mailing Address - Fax:
Practice Address - Street 1:14410 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3624
Practice Address - Country:US
Practice Address - Phone:718-206-1990
Practice Address - Fax:718-206-0051
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0710221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical