Provider Demographics
NPI:1063540433
Name:BOYCHUK, DENISE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:BOYCHUK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452135
Mailing Address - Street 2:NAVAL CONSOLIDATED BRIG MIRAMAR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92145-2135
Mailing Address - Country:US
Mailing Address - Phone:858-577-7041
Mailing Address - Fax:858-577-7154
Practice Address - Street 1:3033 FIFTH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5856
Practice Address - Country:US
Practice Address - Phone:858-577-7041
Practice Address - Fax:858-577-7154
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23339103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist