Provider Demographics
NPI:1003523549
Name:AVDALYAN, MERI
Entity Type:Individual
Prefix:
First Name:MERI
Middle Name:
Last Name:AVDALYAN
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 1:3463 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1856
Mailing Address - Country:US
Mailing Address - Phone:818-206-2442
Mailing Address - Fax:818-875-4660
Practice Address - Street 1:3463 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91214-1856
Practice Address - Country:US
Practice Address - Phone:818-206-2442
Practice Address - Fax:818-875-4660
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-61314103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst