Provider Demographics
NPI:1861760746
Name:BOYER, EVELYN PHIPPS (PHD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:PHIPPS
Last Name:BOYER
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 1:4812 32ND ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2226
Mailing Address - Country:US
Mailing Address - Phone:202-237-0528
Mailing Address - Fax:202-537-1273
Practice Address - Street 1:4424 MONTGOMERY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4409
Practice Address - Country:US
Practice Address - Phone:202-489-8142
Practice Address - Fax:202-237-0528
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01975103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC202424300OtherDOL OWCP