Provider Demographics
NPI:1467814814
Name:JEREJIAN, LUCINE LUCY
Entity Type:Individual
Prefix:MS
First Name:LUCINE
Middle Name:LUCY
Last Name:JEREJIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LUCINE
Other - Middle Name:LUCY
Other - Last Name:JEREJIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6330 MORELLA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3414
Mailing Address - Country:US
Mailing Address - Phone:818-935-4853
Mailing Address - Fax:
Practice Address - Street 1:6330 MORELLA AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3414
Practice Address - Country:US
Practice Address - Phone:818-935-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF5081881103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst