1720112287 NPI number — ROBIN BOYAJIAN LICSW

Table of content: ROBIN BOYAJIAN LICSW (NPI 1720112287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720112287 NPI number — ROBIN BOYAJIAN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYAJIAN
Provider First Name:
ROBIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1720112287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 BURBANK DR
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:
02886-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-749-3301
Provider Business Mailing Address Fax Number:
401-773-7793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 POST ROAD
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-749-3301
Provider Business Practice Location Address Fax Number:
401-773-7793
Provider Enumeration Date:
03/15/2007

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: 101YM0800X , with the licence number:  ISW01127 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: ISW01127 , 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)

  • Identifier: 22891-6 . This is a "BLUE SHIELD HMO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 410576 . This is a "BLUE CHIP COORDINATED HEA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com