Provider Demographics
NPI:1104206903
Name:KRBOYAN, MYDA (LCSW)
Entity Type:Individual
Prefix:
First Name:MYDA
Middle Name:
Last Name:KRBOYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91503-0182
Mailing Address - Country:US
Mailing Address - Phone:818-351-5818
Mailing Address - Fax:818-578-4883
Practice Address - Street 1:2600 W OLIVE AVE STE 500
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4572
Practice Address - Country:US
Practice Address - Phone:818-351-5818
Practice Address - Fax:818-578-4883
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical