Healthcare Provider Details

I. General information

NPI: 1548668460
Provider Name (Legal Business Name): KATHERINE BOECKMAN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GREAT OAKS BLVD # 180D
SAN JOSE CA
95119-1310
US

IV. Provider business mailing address

80 GREAT OAKS BLVD # 180D
SAN JOSE CA
95119-1310
US

V. Phone/Fax

Practice location:
  • Phone: 408-363-3000
  • Fax: 408-363-3046
Mailing address:
  • Phone: 408-363-3000
  • Fax: 408-363-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW63045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: