Provider Demographics
NPI:1144620477
Name:MAGARDECHIAN, LENA (MA)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:MAGARDECHIAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 E BROADWAY UNIT B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1530
Mailing Address - Country:US
Mailing Address - Phone:818-970-5452
Mailing Address - Fax:
Practice Address - Street 1:11777 SEBASTIAN WAY STE AAND102B
Practice Address - Street 2:(909) 989-9724
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0707
Practice Address - Country:US
Practice Address - Phone:909-989-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71891101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)