Provider Demographics
NPI:1437961174
Name:BOYANCE, JEROME LABBE
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:LABBE
Last Name:BOYANCE
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 1:4740 VON KARMAN AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2172
Mailing Address - Country:US
Mailing Address - Phone:949-910-3197
Mailing Address - Fax:949-242-2717
Practice Address - Street 1:4740 VON KARMAN AVE STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2172
Practice Address - Country:US
Practice Address - Phone:949-910-3197
Practice Address - Fax:949-242-2727
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94027650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical