Provider Demographics
NPI:1386344687
Name:BOYD, CAMBRIDGE I SR (ELDER)
Entity type:Individual
Prefix:
First Name:CAMBRIDGE
Middle Name:I
Last Name:BOYD
Suffix:SR
Gender:M
Credentials:ELDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-3162
Mailing Address - Country:US
Mailing Address - Phone:716-495-4782
Mailing Address - Fax:716-842-4069
Practice Address - Street 1:695 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3162
Practice Address - Country:US
Practice Address - Phone:716-495-4782
Practice Address - Fax:716-842-4069
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101Y00000XMedicaid