Provider Demographics
NPI:1295244143
Name:BORIS, JOHN STANLEY (LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STANLEY
Last Name:BORIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15070 N PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-8302
Mailing Address - Country:US
Mailing Address - Phone:630-992-0390
Mailing Address - Fax:
Practice Address - Street 1:15070 N PELHAM RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-8302
Practice Address - Country:US
Practice Address - Phone:630-992-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-15357104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker