Healthcare Provider Details

I. General information

NPI: 1962825687
Provider Name (Legal Business Name): JERALYN BOYD MA, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7162 READING RD STE 500
CINCINNATI OH
45237-3899
US

IV. Provider business mailing address

8425 COTTONWOOD DR APT 3
CINCINNATI OH
45231-5930
US

V. Phone/Fax

Practice location:
  • Phone: 513-761-6222
  • Fax: 513-679-4590
Mailing address:
  • Phone: 513-499-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI. 1700101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: