Individual
JOHN R BOEKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1011 VETERANS MEMORIAL PKWY, EAST PROVIDENCE, RI 02915-5061
(401) 432-1417
(401) 432-1500
Mailing address
1011 VETERANS MEMORIAL PKWY, EAST PROVIDENCE, RI 02915-5061
(401) 432-1284
(401) 432-1509
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS00666
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30160-4
BLUE CROSS
RI
01
—
407017
BLUE CHIP
RI
01
—
61-77966
UNITED BEHAVIORAL HEALTH
RI
05
—
JB29480
—
RI
Enumeration date
05/31/2006
Last updated
01/06/2011
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