Provider Demographics
NPI:1164877767
Name:AYVAZYAN, MARIAM (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:MARIAM
Middle Name:
Last Name:AYVAZYAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 BLEECKER ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1490
Mailing Address - Country:US
Mailing Address - Phone:516-439-3309
Mailing Address - Fax:
Practice Address - Street 1:159 BLEECKER ST APT 2C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1490
Practice Address - Country:US
Practice Address - Phone:516-439-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health