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General NPI Number Information
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NPI Number | 1235393562
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Entity Type | Individual
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Provider Name | JUDY PETTIGREW BOYLE PSY D
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Gender | Female
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 1337 CAMINO DEL MAR SUITE B
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City | DEL MAR
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State | CA
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Zip | 92014
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Country | US
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Telephone | 858-755-7406
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Fax | 858-755-7404
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Provider Business Mailing Address
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Address Line | 13482 CAMINITO CARMEL
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City | DEL MAR
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State | CA
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Zip | 72014
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Country | US
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Telephone | 858-755-7406
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Fax | 858-755-7404
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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 | MFT16828
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License Number State | CA
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