Healthcare Provider Details

I. General information

NPI: 1629403274
Provider Name (Legal Business Name): MARYBETH BOYLAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 MYERS CORNERS RD SUITE 200
WAPPINGERS FALLS NY
12590-3869
US

IV. Provider business mailing address

167 MYERS CORNERS RD SUITE 200
WAPPINGERS FALLS NY
12590-3869
US

V. Phone/Fax

Practice location:
  • Phone: 845-298-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number072046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: