Provider Demographics
NPI:1558073411
Name:BO, AYE THANDA
Entity type:Individual
Prefix:
First Name:AYE
Middle Name:THANDA
Last Name:BO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 THE ALAMEDA STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2222
Mailing Address - Country:US
Mailing Address - Phone:408-239-4574
Mailing Address - Fax:
Practice Address - Street 1:1671 THE ALAMEDA STE 306
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2222
Practice Address - Country:US
Practice Address - Phone:408-784-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW129404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty