Provider Demographics
NPI:1093450710
Name:ZOGRABYAN-ROSTOMYAN, SHOUSHANNA (ACSW)
Entity Type:Individual
Prefix:
First Name:SHOUSHANNA
Middle Name:
Last Name:ZOGRABYAN-ROSTOMYAN
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13522 PINNEY ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2948
Mailing Address - Country:US
Mailing Address - Phone:818-849-8778
Mailing Address - Fax:
Practice Address - Street 1:223 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4380
Practice Address - Country:US
Practice Address - Phone:818-241-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041971041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool