Individual
BEVERLY BOUGHTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
711 SULLIVAN ST, ELMIRA, NY 14901-2322
(607) 737-6151
(607) 734-2943
Mailing address
711 SULLIVAN ST, ELMIRA, NY 14901-2322
(607) 737-6151
(607) 734-2943
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
72079206
NY
1041C0700X
Clinical Social Worker
Primary
083145-1
NY
Other
Enumeration date
07/27/2009
Last updated
12/27/2018
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