Provider Demographics
NPI:1407193204
Name:ISRAELYAN, HASMIK MICHELLE
Entity Type:Individual
Prefix:
First Name:HASMIK
Middle Name:MICHELLE
Last Name:ISRAELYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HASMIK
Other - Middle Name:
Other - Last Name:YEGHIKYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 N CENTRAL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3550
Mailing Address - Country:US
Mailing Address - Phone:818-288-3460
Mailing Address - Fax:
Practice Address - Street 1:229 N CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3550
Practice Address - Country:US
Practice Address - Phone:818-288-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6707794103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst