Provider Demographics
NPI:1114052883
Name:HAJIANI, SUSAN CARLA (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CARLA
Last Name:HAJIANI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 VETERAN AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4569
Mailing Address - Country:US
Mailing Address - Phone:310-966-9171
Mailing Address - Fax:
Practice Address - Street 1:1870 VETERAN AVE APT 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4569
Practice Address - Country:US
Practice Address - Phone:310-966-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical