Provider Demographics
NPI:1053782862
Name:BOYD, JACQUELINE (LMFT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 INTERNATIONAL BLVD
Mailing Address - Street 2:STE 115 PMB 43
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601
Mailing Address - Country:US
Mailing Address - Phone:510-542-9212
Mailing Address - Fax:
Practice Address - Street 1:2648 INTERNATIONAL BLVD
Practice Address - Street 2:STE 115 PMB 43
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601
Practice Address - Country:US
Practice Address - Phone:510-542-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3530106H00000X
DC200001333106H00000X
CA115424106H00000X, 106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program