Provider Demographics
NPI:1255466579
Name:BOHM, JULIA (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BOHM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 LA SELVA ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2109
Mailing Address - Country:US
Mailing Address - Phone:650-573-2326
Mailing Address - Fax:650-349-0476
Practice Address - Street 1:3080 LA SELVA ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2109
Practice Address - Country:US
Practice Address - Phone:650-573-2326
Practice Address - Fax:650-349-0476
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS59781041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical