Basic Information
Provider Information
NPI: 1205144367
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYCE
FirstName: PATRICE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 51 FAWN MEADOW DR
Address2:  
City: NAUGATUCK
State: CT
PostalCode: 067703577
CountryCode: US
TelephoneNumber: 7728341269
FaxNumber:  
Practice Location
Address1: 969 W MAIN ST STE 1D
Address2:  
City: WATERBURY
State: CT
PostalCode: 067082667
CountryCode: US
TelephoneNumber: 2036327020
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/22/2010
LastUpdateDate: 02/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X008891CTY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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