Provider Demographics
NPI:1154684132
Name:BOSWORTH, JANET M (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:M
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2636
Mailing Address - Country:US
Mailing Address - Phone:650-537-7600
Mailing Address - Fax:
Practice Address - Street 1:61 RENATO CT
Practice Address - Street 2:SUITE 18
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-4093
Practice Address - Country:US
Practice Address - Phone:650-537-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist