Provider Demographics
NPI:1346579158
Name:BOYNTON, CATHY L (LADC)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:L
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-1451
Mailing Address - Country:US
Mailing Address - Phone:207-794-2150
Mailing Address - Fax:207-794-6280
Practice Address - Street 1:43 FLEMING ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1451
Practice Address - Country:US
Practice Address - Phone:207-794-2150
Practice Address - Fax:207-794-6280
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2408101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431669799Medicaid