Provider Demographics
NPI:1821248634
Name:BOESKY, JOHN BRANDEIS (MFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRANDEIS
Last Name:BOESKY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 MARLBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2020
Mailing Address - Country:US
Mailing Address - Phone:858-334-4300
Mailing Address - Fax:
Practice Address - Street 1:5100 MARLBOROUGH DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2020
Practice Address - Country:US
Practice Address - Phone:858-334-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health