Provider Demographics
NPI:1124341623
Name:MANERA BOYLE, LORETTA ANN (MED)
Entity type:Individual
Prefix:MR
First Name:LORETTA
Middle Name:ANN
Last Name:MANERA BOYLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 IRISH RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1011
Mailing Address - Country:US
Mailing Address - Phone:610-296-7562
Mailing Address - Fax:
Practice Address - Street 1:301 IRISH RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1011
Practice Address - Country:US
Practice Address - Phone:610-296-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst