Healthcare Provider Details

I. General information

NPI: 1376575720
Provider Name (Legal Business Name): JORGE BOERO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 COLUMBIA AVE
FRANKLIN TN
37064-3921
US

IV. Provider business mailing address

118 N CHURCH ST
MURFREESBORO TN
37130-3636
US

V. Phone/Fax

Practice location:
  • Phone: 615-794-9973
  • Fax: 615-794-9961
Mailing address:
  • Phone: 615-278-2241
  • Fax: 615-904-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2521
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: