MEDICARE: DR. ANNE BOONE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2825	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2290464	OTHER	NC	CIGNA

General Provider Information

NPI Number	:	1649352824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE BOONE PSY.D.

Provider Business Mailing Address
First Line	:	3622 LYCKAN PKWY
Second Line	:	SUITE 4003
City	:	DURHAM
State	:	NC
Zip	:	27707-2564
Country	:	US
Telephone Number	:	919-627-8442
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 LYCKAN PKWY
Second Line	:	SUITE 4003
City	:	DURHAM
State	:	NC
Zip	:	27707-2564
Country	:	US
Telephone Number	:	919-627-8442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	09/27/2010

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