Provider Demographics
NPI:1811605116
Name:BAGHOOMIAN, JULIET (LCSW)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:BAGHOOMIAN
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:PO BOX 3274
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-0274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6444 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2124
Practice Address - Country:US
Practice Address - Phone:818-839-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2025-07-30
Deactivation Date:2024-06-04
Deactivation Code:
Reactivation Date:2025-07-30
Provider Licenses
StateLicense IDTaxonomies
CA1116391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty