Provider Demographics
NPI:1508387069
Name:KASARJIAN, ANISSA (LISW)
Entity Type:Individual
Prefix:MS
First Name:ANISSA
Middle Name:
Last Name:KASARJIAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9734 JUG ST NW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9746
Mailing Address - Country:US
Mailing Address - Phone:740-258-0403
Mailing Address - Fax:
Practice Address - Street 1:9734 JUG ST NW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9746
Practice Address - Country:US
Practice Address - Phone:740-258-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16007141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical