Provider Demographics
NPI:1215967153
Name:BOUGHEY, NANCY L (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:BOUGHEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 TAMAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1645
Mailing Address - Country:US
Mailing Address - Phone:415-457-3959
Mailing Address - Fax:415-457-8106
Practice Address - Street 1:2220 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2222
Practice Address - Country:US
Practice Address - Phone:415-457-3959
Practice Address - Fax:415-457-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS53501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ81622ZMedicare UPIN