Healthcare Provider Details

I. General information

NPI: 1134099716
Provider Name (Legal Business Name): GEORGE BOYER III MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/19/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WINDRIM AVE
PHILADELPHIA PA
19141-2710
US

IV. Provider business mailing address

2401 VICTOR ST
EASTON PA
18042-5324
US

V. Phone/Fax

Practice location:
  • Phone: 215-455-3900
  • Fax:
Mailing address:
  • Phone: 610-438-7629
  • Fax: 610-438-7629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: