Provider Demographics
NPI:1457761116
Name:BOYLE, ANNA M (MED BSL)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:M
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MED BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SAN MARCO DR APT 108
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-0633
Mailing Address - Country:US
Mailing Address - Phone:610-739-8650
Mailing Address - Fax:
Practice Address - Street 1:104 LACOSTA LN STE 120
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-8160
Practice Address - Country:US
Practice Address - Phone:386-304-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PABH000038103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health