Jerry A Boriskin, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0003779 Issued in FL

Practice address

150 Muir Rd
Martinez, CA 94553-4668

Phone

(561) 703-6106

NPI assigned

Feb 3, 2009

Last updated

Feb 3, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233619200000",
    "number": "1689812364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MUIR ROAD",
            "city": "MARTINEZ",
            "state": "CA",
            "postal_code": "94553",
            "telephone_number": "561-703-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MUIR RD",
            "city": "MARTINEZ",
            "state": "CA",
            "postal_code": "945534668",
            "telephone_number": "561-703-6106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORISKIN",
        "first_name": "JERRY",
        "middle_name": "A",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-03",
        "last_updated": "2009-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "PY0003779",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0003779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence Raymond Boly, MD
• Brea Bondi-Boyd, MD
• Janette L Booher Fulton, D.C.
• Lauren Diana Borden
• Lou Anthony Bordisso
• Zachary Bosshardt, MD
• Jamie Boudreau, M.D.
• Elizabeth Anne Bourell, RN,NP
• Gerald W. Bourne, MD
• Parveen Nahel Bourne, RN

• Clinical Psychologist in Martinez, CA
• Providers in Martinez, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.