Provider Demographics
NPI:1306480140
Name:BOYD FERMIN, ASHLEY M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:M
Last Name:BOYD FERMIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5450
Mailing Address - Country:US
Mailing Address - Phone:617-632-6859
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-3455
Practice Address - Fax:617-394-2624
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker