Provider Demographics
NPI:1841307105
Name:BOREN, PAIGE A (CDP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:A
Last Name:BOREN
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 MADRONA WAY NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1869
Mailing Address - Country:US
Mailing Address - Phone:206-854-9080
Mailing Address - Fax:
Practice Address - Street 1:154 MADRONA WAY NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1869
Practice Address - Country:US
Practice Address - Phone:206-854-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005765101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992825Medicaid
WA910875163-19OtherKPS ID#
WAPO1521OtherREGENCE RIDER#