Individual
DR. EDWIN D BOUDREAUX
Active
Individual
DR. EDWIN D BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
9227
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001663773
AMERIHEALTH PPO
—
01
—
2321722000
AMERIHEALTH HMO, KEYSTONE, IBC
—
01
—
3K6039
HEALTHNET
—
01
—
42304
UNIVERSITY HEALTHPLAN
—
01
—
476594000
MAGELLAN
—
01
—
7663465
AETNA
—
05
—
8879800
—
NJ
Enumeration date
10/11/2006
Last updated
01/25/2017
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