Provider Demographics
NPI:1194132829
Name:BOYLE, LENA LORRAINE (LICSWA)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:LORRAINE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:LICSWA
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 502
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0502
Mailing Address - Country:US
Mailing Address - Phone:509-216-5815
Mailing Address - Fax:
Practice Address - Street 1:208 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9755
Practice Address - Country:US
Practice Address - Phone:509-429-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC608562181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical