Provider Demographics
NPI:1326487802
Name:PETROSIAN, SUZANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:PETROSIAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:DERMEGUERDITCHIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2919 LOS OLIVOS LN
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2814
Mailing Address - Country:US
Mailing Address - Phone:626-792-8797
Mailing Address - Fax:626-792-8798
Practice Address - Street 1:2919 LOS OLIVOS LN
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2814
Practice Address - Country:US
Practice Address - Phone:626-792-8797
Practice Address - Fax:626-792-8798
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI74872101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)