Provider Demographics
NPI:1629629563
Name:BOIRE, JANETTE LESLIE
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:LESLIE
Last Name:BOIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 VAN NUYS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1700
Mailing Address - Country:US
Mailing Address - Phone:626-344-2012
Mailing Address - Fax:
Practice Address - Street 1:4940 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1700
Practice Address - Country:US
Practice Address - Phone:818-985-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118719106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist