Provider Demographics
NPI:1316778962
Name:BORON, BRYCE (CT)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:BORON
Suffix:
Gender:M
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20435 KELSEY LN
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-0967
Mailing Address - Country:US
Mailing Address - Phone:440-596-1411
Mailing Address - Fax:
Practice Address - Street 1:4983 RIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9738
Practice Address - Country:US
Practice Address - Phone:440-596-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405802-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health