Healthcare Provider Details

I. General information

NPI: 1366698722
Provider Name (Legal Business Name): JOSEPH D. BOIVIN LPC/LADC/CHES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2008
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MAIN ST
ELLINGTON CT
06029-3360
US

IV. Provider business mailing address

995 DAY HILL RD
WINDSOR CT
06095-1722
US

V. Phone/Fax

Practice location:
  • Phone: 860-871-5402
  • Fax: 860-871-5413
Mailing address:
  • Phone: 860-731-5522
  • Fax: 860-731-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001186
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000565
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: