Provider Demographics
NPI:1114624830
Name:BALASANYAN, SYUZANNA
Entity Type:Individual
Prefix:
First Name:SYUZANNA
Middle Name:
Last Name:BALASANYAN
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 1:11024 RHODESIA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2128
Mailing Address - Country:US
Mailing Address - Phone:818-384-0031
Mailing Address - Fax:
Practice Address - Street 1:11024 RHODESIA AVE
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2128
Practice Address - Country:US
Practice Address - Phone:818-384-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical