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General NPI Number Information
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NPI Number | 1871212688
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Entity Type | Individual
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Provider Name | CARLY BOUGHNER
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Gender | Female
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 400 S CROSS ST STE 1
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City | CHESTERTOWN
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State | MD
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Zip | 21620-4705
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Country | US
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Telephone | 844-244-5264
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Fax |
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Provider Business Mailing Address
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Address Line | 142 COURSEVALL DR
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City | CENTREVILLE
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State | MD
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Zip | 21617-1824
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 28882
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License Number State | MD
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