Provider Demographics
NPI:1730245564
Name:BOYD-JACKSON, SHARON F (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:F
Last Name:BOYD-JACKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 MORRIS AVE
Mailing Address - Street 2:SUITE # 308
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4850
Mailing Address - Country:US
Mailing Address - Phone:908-688-7979
Mailing Address - Fax:908-687-5414
Practice Address - Street 1:2810 MORRIS AVE
Practice Address - Street 2:SUITE # 308
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4850
Practice Address - Country:US
Practice Address - Phone:908-688-7979
Practice Address - Fax:908-687-5414
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2986OtherHORIZON BLUE CROSS BLUE S