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General NPI Number Information
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NPI Number | 1093875304
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Entity Type | Individual
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Provider Name | WENDY A BOIVIN M.S. L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15 OLD BEACH RD
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City | NEWPORT
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State | RI
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Zip | 02840-3285
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Country | US
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Telephone | 401-742-0861
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Fax |
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Provider Business Mailing Address
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Address Line | 203 MULBERRY DR
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City | WAKEFIELD
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State | RI
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Zip | 02879-2405
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Country | US
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Telephone | 401-792-0987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 00107
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License Number State | RI
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