Healthcare Provider Details

I. General information

NPI: 1679801278
Provider Name (Legal Business Name): DOROTHY L BOSTON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15167 HUNTINGTON RD
GALLIPOLIS FERRY WV
25515-6615
US

IV. Provider business mailing address

2585 3RD AVE
HUNTINGTON WV
25703-1642
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-5725
  • Fax: 304-675-5727
Mailing address:
  • Phone: 304-697-1396
  • Fax: 304-697-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6843
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number749
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: