Provider Demographics
NPI:1093328411
Name:JAMGHARTANIAN, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:JAMGHARTANIAN
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 1:3107 KINGRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1028
Mailing Address - Country:US
Mailing Address - Phone:818-395-5037
Mailing Address - Fax:
Practice Address - Street 1:3857 FOOTHILL BLVD STE 1F
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91214-1653
Practice Address - Country:US
Practice Address - Phone:818-395-5037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119878106H00000X
CA142038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist