Provider Demographics
NPI:1063590289
Name:BOYLAN, WILLIAM (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BOYLAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 E 2ND ST
Mailing Address - Street 2:#5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7736
Mailing Address - Country:US
Mailing Address - Phone:917-587-6959
Mailing Address - Fax:212-228-4678
Practice Address - Street 1:186 E 2ND ST
Practice Address - Street 2:#5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7736
Practice Address - Country:US
Practice Address - Phone:917-587-6959
Practice Address - Fax:212-228-4678
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18200101YA0400X
NY0734561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical