Provider Demographics
NPI:1154452332
Name:ASSILIAN, ANETT ABRAHAMIAN (PSYD)
Entity Type:Individual
Prefix:
First Name:ANETT
Middle Name:ABRAHAMIAN
Last Name:ASSILIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18917 NORDHOFF ST STE 18
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4823
Mailing Address - Country:US
Mailing Address - Phone:818-419-9341
Mailing Address - Fax:
Practice Address - Street 1:18917 NORDHOFF ST STE 18
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4823
Practice Address - Country:US
Practice Address - Phone:818-419-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27128103T00000X
CA27128103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114302189OtherNPPES