Provider Demographics
NPI:1871551036
Name:BORIS, JOAN (MFT)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:BORIS
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 1:1560 E CHEVY CHASE DR
Mailing Address - Street 2:STE 130
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4197
Mailing Address - Country:US
Mailing Address - Phone:818-240-0340
Mailing Address - Fax:818-545-7672
Practice Address - Street 1:2211 W MAGNOLIA BLVD
Practice Address - Street 2:STE 100
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1753
Practice Address - Country:US
Practice Address - Phone:818-240-0340
Practice Address - Fax:818-566-1085
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist