Provider Demographics
NPI:1528270378
Name:BOSWELL, PHILIP CARPENTER (PHD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:CARPENTER
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CATALONIA AVE
Mailing Address - Street 2:SUITE 802
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6735
Mailing Address - Country:US
Mailing Address - Phone:305-445-1400
Mailing Address - Fax:
Practice Address - Street 1:250 CATALONIA AVE
Practice Address - Street 2:SUITE 802
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6735
Practice Address - Country:US
Practice Address - Phone:305-445-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74416Medicare ID - Type Unspecified
FLR04069Medicare UPIN