Provider Demographics
NPI:1477228666
Name:MANIKYAN, SUSANNA (RADT)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:MANIKYAN
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1805
Mailing Address - Country:US
Mailing Address - Phone:626-808-3709
Mailing Address - Fax:
Practice Address - Street 1:160 N EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1805
Practice Address - Country:US
Practice Address - Phone:626-792-2770
Practice Address - Fax:626-792-5829
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)