Healthcare Provider Details

I. General information

NPI: 1629993357
Provider Name (Legal Business Name): MARGARET ROSE BOYLE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

1 RICHMOND ST APT 1042
NEW BRUNSWICK NJ
08901-4106
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-1880
  • Fax:
Mailing address:
  • Phone: 609-462-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00750200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: