Provider Demographics
NPI:1023373784
Name:ORYAN, JUSTIAN ELIZABETH (MSW, ASW)
Entity Type:Individual
Prefix:MS
First Name:JUSTIAN
Middle Name:ELIZABETH
Last Name:ORYAN
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 CARMEL AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5220
Mailing Address - Country:US
Mailing Address - Phone:209-405-0859
Mailing Address - Fax:
Practice Address - Street 1:555 W BENJAMIN HOLT DR
Practice Address - Street 2:SUITE 400
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3839
Practice Address - Country:US
Practice Address - Phone:209-478-9862
Practice Address - Fax:209-478-1938
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29226OtherBOARD OF BEHAVIORAL SCIENCES