MEDICARE: PATRICK EDWARD BOYLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	0004916	OH

General Provider Information

NPI Number	:	1174853055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK EDWARD BOYLE

Provider Business Mailing Address
First Line	:	2490 LEE BLVD
Second Line	:	SUITE 314
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1268
Country	:	US
Telephone Number	:	216-287-6691
Fax Number	:	216-398-6350

Provider Business Practice Location Address
First Line	:	2490 LEE BLVD
Second Line	:	SUITE 314
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1268
Country	:	US
Telephone Number	:	216-287-6691
Fax Number	:	216-398-6350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	12/28/2009

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Directions to “ PATRICK EDWARD BOYLE ” Practice Location

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