Provider Demographics
NPI:1619712577
Name:BOITS, ANNAMARIE (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:
Last Name:BOITS
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:ANNAMARIE
Other - Middle Name:
Other - Last Name:TIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, NCSP
Mailing Address - Street 1:3233 S 925 E
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:46554-9512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 BERKLEY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1817
Practice Address - Country:US
Practice Address - Phone:574-936-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10212178103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty