Provider Demographics
NPI:1932582962
Name:PATTI BORO, LMFT
Entity Type:Organization
Organization Name:PATTI BORO, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:415-789-7657
Mailing Address - Street 1:1000 5TH AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-6104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 5TH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-6104
Practice Address - Country:US
Practice Address - Phone:415-789-7657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41722302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization