Healthcare Provider Details

I. General information

NPI: 1831700103
Provider Name (Legal Business Name): REBECCA G BOSWELL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 GOLD ST APT 106
NEW HAVEN CT
06519-1641
US

IV. Provider business mailing address

22 GOLD ST APT 106
NEW HAVEN CT
06519-1641
US

V. Phone/Fax

Practice location:
  • Phone: 786-210-9796
  • Fax:
Mailing address:
  • Phone: 786-210-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPST00249
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPST00249
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: