1477927010 NPI number — MEGAN BOOHER

Table of content: MEGAN BOOHER (NPI 1477927010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477927010 NPI number — MEGAN BOOHER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOHER
Provider First Name:
MEGAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOOHER
Provider Other First Name:
MEGAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477927010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 CANONCHET AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02888-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-849-2300
Provider Business Mailing Address Fax Number:
401-841-8841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 JOHN CLARKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02842-5641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-849-2300
Provider Business Practice Location Address Fax Number:
401-841-8841
Provider Enumeration Date:
11/19/2015

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: 106H00000X , with the licence number:  MFT00165 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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