Provider Demographics
NPI:1245216480
Name:BOSWELL, RONALD JESS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JESS
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7685 SW 104 ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:305-666-8000
Mailing Address - Fax:305-666-4311
Practice Address - Street 1:7685 SW 104 ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-666-8000
Practice Address - Fax:305-666-4311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 0001323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist