Provider Demographics
NPI:1386231587
Name:BOSKOVICH, BRIANA NICOLE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:NICOLE
Last Name:BOSKOVICH
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 1:225 SIMI VILLAGE DR # 940202
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-7001
Mailing Address - Country:US
Mailing Address - Phone:818-451-8585
Mailing Address - Fax:
Practice Address - Street 1:5550 TELEGRAPH RD STE C3
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4263
Practice Address - Country:US
Practice Address - Phone:805-222-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X, 390200000X
CA137877106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program