MEDICARE: THERESA T BOSWELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	7261 123	WI
2	1041C0700X	Clinical Social Worker	76405	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376749598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA T BOSWELL LCSW

Provider Business Mailing Address
First Line	:	1860 HOWE AVE
Second Line	:	SUITE 440
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-1073
Country	:	US
Telephone Number	:	916-569-8484
Fax Number	:	916-550-5003

Provider Business Practice Location Address
First Line	:	1908 N BEALE RD
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-6937
Country	:	US
Telephone Number	:	530-743-6888
Fax Number	:	530-743-9823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	05/26/2020

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