MEDICARE: RONELLE BOYD LCSW

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	171M00000X	Case Manager/Care Coordinator	57001	TX
2	1041C0700X	Clinical Social Worker	57001	TX

General Provider Information

NPI Number	:	1437530680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONELLE BOYD LCSW

Provider Business Mailing Address
First Line	:	7109 CANISIUS CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-1383
Country	:	US
Telephone Number	:	817-247-2529
Fax Number	:

Provider Business Practice Location Address
First Line	:	7109 CANISIUS CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-1383
Country	:	US
Telephone Number	:	817-247-2529
Fax Number	:

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

Provider Enumeration Date	:	06/13/2015
Last Update Date	:	03/25/2022

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