Basic Information
| Provider Information | |||||||||
| NPI: | 1679801278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSTON | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2585 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257031642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046971396 | ||||||||
| FaxNumber: | 3046972086 | ||||||||
| Practice Location | |||||||||
| Address1: | 15167 HUNTINGTON RD | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS FERRY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255156615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046755725 | ||||||||
| FaxNumber: | 3046755727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2009 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6843 | OH | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 749 | WV | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.