Provider Demographics
NPI:1306383062
Name:BOLANDIAN, PARDIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PARDIS
Middle Name:
Last Name:BOLANDIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PARDIS
Other - Middle Name:
Other - Last Name:BOLANDIAN-ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:11838 KIOWA AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6020
Mailing Address - Country:US
Mailing Address - Phone:310-266-6776
Mailing Address - Fax:
Practice Address - Street 1:19725 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3650
Practice Address - Country:US
Practice Address - Phone:310-247-8712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1829726103K00000X
CAPSY 24206103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11829726OtherBOARD OF APPLIED BEHAVIOR ANALYSIS