Provider Demographics
NPI:1730889833
Name:BOYD, MALIK
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S 56TH STREET
Mailing Address - Street 2:COMM
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143
Mailing Address - Country:US
Mailing Address - Phone:267-930-2274
Mailing Address - Fax:
Practice Address - Street 1:324 S 56TH STREET
Practice Address - Street 2:COMM
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143
Practice Address - Country:US
Practice Address - Phone:267-930-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171400000XOther Service ProvidersHealth & Wellness Coach
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program