Provider Demographics
NPI:1346371374
Name:OVANESSIAN, MARINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:OVANESSIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 S HUDSON AVE RM 208
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3507
Mailing Address - Country:US
Mailing Address - Phone:626-396-3600
Mailing Address - Fax:
Practice Address - Street 1:351 S HUDSON AVE RM 208
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3507
Practice Address - Country:US
Practice Address - Phone:626-396-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-11-24
Deactivation Date:2010-11-02
Deactivation Code:
Reactivation Date:2012-10-18
Provider Licenses
StateLicense IDTaxonomies
CA665391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical