Provider Demographics
NPI:1285617589
Name:BOORE, JUDITH ANNE (MFT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:BOORE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 FREMONT AVE
Mailing Address - Street 2:STE.107
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5617
Mailing Address - Country:US
Mailing Address - Phone:650-948-9138
Mailing Address - Fax:
Practice Address - Street 1:871 FREMONT AVE
Practice Address - Street 2:STE. 107
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5617
Practice Address - Country:US
Practice Address - Phone:650-948-9138
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist