Provider Demographics
NPI:1902298144
Name:BOYKIN, NISSA ERIN
Entity Type:Individual
Prefix:
First Name:NISSA
Middle Name:ERIN
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3356
Mailing Address - Country:US
Mailing Address - Phone:609-364-9523
Mailing Address - Fax:
Practice Address - Street 1:770 WOODLANE ROAD
Practice Address - Street 2:
Practice Address - City:MT. HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-267-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health