Provider Demographics
NPI:1386965432
Name:BOSWORTH, LAURA DIANE (MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DIANE
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:DIANE
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12881 KNOTT ST STE 109
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3939
Mailing Address - Country:US
Mailing Address - Phone:562-716-3461
Mailing Address - Fax:
Practice Address - Street 1:12881 KNOTT ST STE 109
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3939
Practice Address - Country:US
Practice Address - Phone:562-716-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist