=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851025779
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. ALICIA BOYKIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2022
-----------------------------------------------------
Last Update Date | 07/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 E SUNRISE HWY STE 500
-----------------------------------------------------
City | VALLEY STREAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11581-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-357-4540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21711 136TH AVE
-----------------------------------------------------
City | SPRINGFIELD GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11413-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-621-7996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | P116234
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------