Basic Information
| Provider Information | |||||||||
| NPI: | 1083924880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOE | ||||||||
| FirstName: | CAROLINA | ||||||||
| MiddleName: | SERNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746088 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303746088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1273397303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 712 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029071465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012335060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2010 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.