Provider Demographics
NPI:1710500459
Name:BORHO, JEAN GRIFFIN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:GRIFFIN
Last Name:BORHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ELLEN
Other - Last Name:ELLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3906 ALTA MESA DR
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4009
Mailing Address - Country:US
Mailing Address - Phone:310-429-8698
Mailing Address - Fax:
Practice Address - Street 1:17777 VENTURA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3738
Practice Address - Country:US
Practice Address - Phone:213-445-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical