Provider Demographics
NPI:1801931274
Name:JERRY E. BOYER, PH.D., P.C.
Entity type:Organization
Organization Name:JERRY E. BOYER, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-248-1174
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-3111
Mailing Address - Country:US
Mailing Address - Phone:717-248-1174
Mailing Address - Fax:717-248-1175
Practice Address - Street 1:47 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2202
Practice Address - Country:US
Practice Address - Phone:717-248-1174
Practice Address - Fax:717-248-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002678L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03106000OtherCBC GROUP ID