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General NPI Number Information
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NPI Number | 1154485886
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Entity Type | Individual
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Provider Name | WILLIAM BERNARD BOSTON LPC
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1012 14TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20005-3403
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Country | US
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Telephone | 202-737-2554
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Fax |
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Provider Business Mailing Address
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Address Line | 3319 14TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-2902
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Country | US
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Telephone | 202-415-2158
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PR962
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License Number State | DC
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