Active NPI
Avery Robert Boras, MD
- Psychologist
- Mandeville, LA
National Provider Identifier
1609091719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 964
- Practice address
- 23515 Hwy 190
Mandeville, LA 70470 - Phone
- (985) 626-6300
- Fax
- (985) 626-6467
- NPI assigned
- Apr 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 964 | LA | Primary |
Addresses
Primary practice location
23515 Hwy 190
Mandeville, LA 70470
Mailing address
PO Box 3850
23515 Hwy 190
Mandeville, LA 70470-3850
Phone (985) 626-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 964 | LA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609091719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3850",
"address_2": "23515 HWY 190",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704703850",
"telephone_number": "985-626-6300",
"fax_number": "985-626-6467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23515 HWY 190",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "70470",
"telephone_number": "985-626-6300",
"fax_number": "985-626-6467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORAS",
"first_name": "AVERY",
"middle_name": "ROBERT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "LA",
"license": "964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.