Provider Demographics
NPI:1912940818
Name:BOYD, JENNIFER ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:BOYD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:BOYD
Other - Last Name:RITSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4150 CLEMENT ST
Mailing Address - Street 2:PSYCHIATRY (116A)
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1545
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-668-7503
Practice Address - Street 1:1801 BUSH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5239
Practice Address - Country:US
Practice Address - Phone:415-572-5838
Practice Address - Fax:415-668-7503
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL177530Medicare UPIN