Individual
JOHN R BOEKAMP
Active
Individual
JOHN R BOEKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
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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