Provider Demographics
NPI:1992909022
Name:BOYER, JEFFREY TODD (ACSW, LMSW, CAADC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TODD
Last Name:BOYER
Suffix:
Gender:M
Credentials:ACSW, LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21409 RIVERWALK CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-4267
Mailing Address - Country:US
Mailing Address - Phone:313-418-9033
Mailing Address - Fax:248-957-8473
Practice Address - Street 1:670 GRISWOLD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2675
Practice Address - Country:US
Practice Address - Phone:248-347-3470
Practice Address - Fax:248-347-2242
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010891951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid