Provider Demographics
NPI:1558772111
Name:BOSWELL, JOHN LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEE
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 VISTA PARKWAY SUITE 259
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2706
Mailing Address - Country:US
Mailing Address - Phone:561-932-5342
Mailing Address - Fax:561-516-6942
Practice Address - Street 1:2101 VISTA PARKWAY SUITE 259
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2706
Practice Address - Country:US
Practice Address - Phone:561-932-5342
Practice Address - Fax:561-516-6942
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW146171041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty