Provider Information for 1942610522
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REBECCA E. BOARDMAN LICSW
Sex: Female
NPI: 1942610522
Last Updated: 2020-10-01
Certification Date: 2020-10-01
Certification Date: 2020-10-01
Details
| Name | Value | ||||||||
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| NPI | 1942610522 | ||||||||
| Enumeration Date | 2014-05-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2157 GREENBRIER ST CHARLESTON, WV 25311-9623 United States Phone: 304-344-5924 | Fax:304-356-3239 | ||||||||
| Primary Practice Address | 511 MORRIS ST CHARLESTON, WV 25301-1326 United States Phone: 304-341-0511 | Fax:304-341-0499 | ||||||||
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