Healthcare Provider Details

I. General information

NPI: 1154684132
Provider Name (Legal Business Name): JANET M. BOSWORTH M.A., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 LAUREL ST UNIT 195
SAN CARLOS CA
94070-7711
US

IV. Provider business mailing address

809 LAUREL ST UNIT 195
SAN CARLOS CA
94070-7711
US

V. Phone/Fax

Practice location:
  • Phone: 650-218-3275
  • Fax:
Mailing address:
  • Phone: 650-218-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT50580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: