Provider Demographics
NPI:1598009458
Name:SERABIAN, SEBOUH J (MS BCBA)
Entity Type:Individual
Prefix:
First Name:SEBOUH
Middle Name:J
Last Name:SERABIAN
Suffix:
Gender:M
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W HEFFRON DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3426
Mailing Address - Country:US
Mailing Address - Phone:323-397-6580
Mailing Address - Fax:
Practice Address - Street 1:4001 W HEFFRON DR
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3426
Practice Address - Country:US
Practice Address - Phone:323-397-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8796103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst