Provider Demographics
NPI:1821401787
Name:BOGHOSIAN, BRANDIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRANDIE
Middle Name:
Last Name:BOGHOSIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4973
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91308-4973
Mailing Address - Country:US
Mailing Address - Phone:818-624-3062
Mailing Address - Fax:
Practice Address - Street 1:30200 AGOURA RD STE 190
Practice Address - Street 2:
Practice Address - City:AGOURA
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-624-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical