1033383286 NPI number — MISS MARKIETA JOYCE BOSWELL MA, LPC

Table of content: MISS MARKIETA JOYCE BOSWELL MA, LPC (NPI 1033383286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033383286 NPI number — MISS MARKIETA JOYCE BOSWELL MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOSWELL
Provider First Name:
MARKIETA
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033383286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8742 CUMBRIA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WASHINGTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20744-7164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-210-8380
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36185 GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48335-3044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-778-7573
Provider Business Practice Location Address Fax Number:
248-991-9533
Provider Enumeration Date:
04/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401019588 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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