Provider Demographics
NPI:1003395518
Name:PETROSSIAN, MELISSA (BA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PETROSSIAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 PIONEER DR APT 30
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1721
Mailing Address - Country:US
Mailing Address - Phone:818-395-3436
Mailing Address - Fax:
Practice Address - Street 1:1450 N LAKE AVE # 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2301
Practice Address - Country:US
Practice Address - Phone:626-794-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)