Corwin Boake, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

23147 Issued in TX

Practice address

1333 Moursund St
Houston, TX 77030-3405

Phone

(713) 799-6990

Fax

(713) 799-7049

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Memorial Hermann Health System

  dba TIRR Memorial Hermann

  • Rehabilitation Hospital
  • Houston, TX
  • NPI 1710985098
  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364601600000",
    "number": "1942349451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MOURSUND ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303405",
            "telephone_number": "713-799-6990",
            "fax_number": "713-799-7049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 MOURSUND ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303405",
            "telephone_number": "713-799-6990",
            "fax_number": "713-799-7049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOAKE",
        "first_name": "CORWIN",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2013-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "23147",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "23147",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "LA",
            "license": "MP.0661",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1625642",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ali Bo Abbas, DDS
• Jie Bo
• Glaiza Micu Boado, AGACNP-BC
• Taylor Boagni, PA-C
• Nina Boaitey, PHARMD
• Dale Fenn Boardman, DO
• Darcy Elizabeth Boardman
• Dennis Boardman, M.D.
• Agartha Boateng
• Ahmed Kwadwo Boateng, APRN,FNP-C,PMHNP-BC

• Clinical Neuropsychologist in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Neuropsychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2013; 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.