Healthcare Provider Details

I. General information

NPI: 1609178318
Provider Name (Legal Business Name): HERBERT A BOYD JR. LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 PENNSYLVANIA AVE SE SUITE 213
WASHINGTON DC
20020-3722
US

IV. Provider business mailing address

3230 PENNSYLVANIA AVE SE SUITE 213
WASHINGTON DC
20020-3736
US

V. Phone/Fax

Practice location:
  • Phone: 202-583-1181
  • Fax: 202-583-1186
Mailing address:
  • Phone: 202-583-1181
  • Fax: 202-583-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC300476
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: