Boston, Jeffrey Theodore

Boston, Jeffrey Theodore is an sole proprietor health care provider with primary practice located at 821 Raymond Ave Suite 150, Saint Paul MN 55114-1503. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Boston, Jeffrey Theodore can be contacted via phone (651) 642-9741.

Contact Information

Primary practice address
821 Raymond Ave Suite 150 Saint Paul MN 55114-1503
Phone: (651) 642-9741
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP3768 Minnesota

Profile Details

NPI number 1649394156
LBN Legal business name Boston, Jeffrey Theodore
Credentials PSY.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 19th, 2007
Last updated Feb 26th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649394156 NPPES
Minnesota Other 245L9BO BLUE CROSS BLUE SHIELD
Minnesota MEDICAID 184314100 BLUE CROSS BLUE SHIELD

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